A man you can bait with a Tweet

[zoogs]

Yeah, that threw me for a loop as well. I thought it was the other one

 

The whole deal has to be sustainable for any of it to work long term. The cost problem is bad enough that it simply cannot be ignored.

I do agree that we can't ignore the problem. In the short term, I don't think the ACA is unsustainable. At least, relative to the alternatives, it is more so. However, we need continued progress on the whole and I think that's a given.

 

The only reason to harp on the 'sustainable' aspect of this is again, the various claims that the ACA is in a death spiral, etc, etc. It will take sabotage to get there. We can make it function as a better-than-the-alternatives bridge until we come up with some better ones.

[zoogs]

I cannot believe this system is working very well for anybody that makes less than $150K or $200K per year.

I think it's working best for the people who are either on the very, very low end of income or people who couldn't get coverage at all before for other reasons.

 

I think they could have done a better job in the upper middle (but not quite super upper middle) bracket. A common reason cited for not doing so, I believe, is the weakness of the mandate penalty. But, yeah. Ultimately, the ACA plays pretty nice with the insurance companies, doesn't it? It's why so many people want to see that eventual move to single payer, right?

 

In my mind, that makes the cost issue even more imperative than securing free coverage for a few more people who are still going to go broke if they have any medical issues.

I think this understates the options for the people who are getting coverage. As much as I do agree that "this is crazy expensive" is a problem, "47 million Americans couldn't get healthcare" seems like a bigger one to me. Especially because we all benefit from a healthier society.

[JJ Husker]

Yeah, that threw me for a loop as well. I thought it was the other one

 

The whole deal has to be sustainable for any of it to work long term. The cost problem is bad enough that it simply cannot be ignored.

I do agree that we can't ignore the problem. In the short term, I don't think the ACA is unsustainable. At least, relative to the alternatives, it is more so. However, we need continued progress on the whole and I think that's a given.

 

The only reason to harp on the 'sustainable' aspect of this is again, the various claims that the ACA is in a death spiral, etc, etc. It will take sabotage to get there. We can make it function as a better-than-the-alternatives bridge until we come up with some better ones.

 

 

I don't subscribe to the fringe portrayal of the ACA being in a death spiral. However, healthcare generally is in death spiral and the ACA is, for better or worse, now part of the healthcare landscape in this country. If it keeps losing insurers and costs keep escalating at current rates, the things it actually made better will not amount to anything. The ACA didn't cause the cost problems but it did darned little to help them either. I agree that it may be better than what we had but it's really not much better than out of the fire and into the frying pan. Considering the current state of things, we may have months to fix it but not years. I shudder to think what it will be like 3-4 years from now if nothing is done.

[zoogs]

If it keeps losing insurers and costs keep escalating at current rates, the things it actually made better will not amount to anything.

Right, and I know much has been made of this or that insurer as well as premium costs -- and the analysis of those as a "one-time adjustment". So to me, it seems like this is a big if.

 

Not to say it's hunky dory. Just that I'm not sure many of these softer, less fringe portrayals of the current ACA state are accurate either. To the contrary, it seemed to me like there was a strong argument that it was stabilizing -- still inadequate in terms of reining in the basic cost problem, and still less coverage expansion than we'd hoped -- but nonetheless, it goes against the fix-or-collapse narrative.

 

None of that is an argument against moving to single payer if this becomes politically viable tomorrow, of course. Nor is it a suggestion that we stop tweaking and improving it. The problem is we're sort of having the opposite debate. We've been on the verge of dismantling it instead.

[NM11046]

 

So cost is more important an issue than citizens being protected El Diaco? Not poking the bear - just looking for clarity. I think perhaps the priorities of these two issues may be different depending on perspective (and sadly maybe party lines to some extent).

 

IMO I believe it is more important. The whole deal has to be sustainable for any of it to work long term. The cost problem is bad enough that it simply cannot be ignored. I do not believe party lines are affecting my outlook at all because there is currently no party I even remotely agree with.

 

I will acknowledge that a lot of my opinion comes from my personal experience (imagine that...). I make a decent living but even at that it is a struggle to pay for health insurance and healthcare. Premiums run me about $20,000 per year and this previous year 2 of us hit our max out of pockets so that is another $11,000 +/- in expenses. Mine maxed out on basically just routine care and a colonoscopy. I make too much to get any help with the premiums or to be able to deduct any costs on my tax return. There are many people in the same boat who make even less than I do but get no subsidy and do not meet the threshold for deducting costs. Yeah, it would be worse if I could not get coverage at all due to pre-existing conditions or if my income were poverty level and I wasn't able to afford it at all but the current system really only works without strain for those in the top 2% or 3% of income. Maybe I happen to be in some freak income bubble but it sure seems like healthcare and health insurance expenses should not be the only difference between being financially very comfortable or being broke. I cannot believe this system is working very well for anybody that makes less than $150K or $200K per year. Isn't that most everybody? Or possibly I'm getting old and $150,000+/- just isn't what it used to be. I don't think it is reasonable that, if a person/family has one or two routine medical issues, it should consume 25% to 100%+ of their yearly income. In my mind, that makes the cost issue even more imperative than securing free coverage for a few more people who are still going to go broke if they have any medical issues.

 

Totally understand - I've been accused of being too optimistic and blind to the negatives (in life in general - which usually results in me being deeply disappointed), so I guess my pipe dream is that we've (as a whole) avoided putting people in situations where they're totally screwed by not being prepared. And those of us who are better off have the obligation to step up and do more for those who have less.

 

I've certainly seen some of my out of pocket costs go up, but chalked that up to my increasing health issues and thinking that that's kinda going to be the case as I grow older. (and honestly the ACA gave me some comfort as I grow older that I'd have help if needed). For me the benefit of basic routine stuff being covered has been a cost savings (annual physicals etc) so it's basically been a wash.

 

I work in the healthcare field, and can say that I see a benefit with patients who otherwise would be going to the ER only when things were critical (or worse, using the ER for basic healthcare and taking that resource away from someone who needs urgent care). I think that the long term benefit from having more people being covered won't be seen for many, many years. And right now nobody is able to show that as a tangible.

 

Cost is something that needs to be acknowledged, I just don't think it was the main goal of the initial action of putting the ACA in place - getting care to those without it was step one.

[JJ Husker]

 

I cannot believe this system is working very well for anybody that makes less than $150K or $200K per year.

I think it's working best for the people who are either on the very, very low end of income or people who couldn't get coverage at all before for other reasons.

 

I think they could have done a better job in the upper middle (but not quite super upper middle) bracket. A common reason cited for not doing so, I believe, is the weakness of the mandate penalty. But, yeah. Ultimately, the ACA plays pretty nice with the insurance companies, doesn't it? It's why so many people want to see that eventual move to single payer, right?

 

In my mind, that makes the cost issue even more imperative than securing free coverage for a few more people who are still going to go broke if they have any medical issues.

I think this understates the options for the people who are getting coverage. As much as I do agree that "this is crazy expensive" is a problem, "47 million Americans couldn't get healthcare" seems like a bigger one to me. Especially because we all benefit from a healthier society.

 

 

I don't really disagree but, if you remove the humanity aspect, all it really accomplished was funneling more tax payer dollars to insurers, pharma and healthcare providers. It's great for those who can now get heavily subsidized to free coverage. Not so great for the people who have to pay for their own coverage and pay taxes. Once again, the winners are the ultra rich, the ultra poor and big business. Seems to be a theme with anything our government touches. Keep everybody distracted with "this side vs that side" while they squeeze more and more money from the middle. Being part of that middle, I'm pretty much fed up with it, you guise. I have to believe that sentiment is not mine alone and it is what made it possible for the train wreck we have in the WH.

[Danny Bateman]

I can't pretend to follow the thought train from "Washington is squeezing the middle class" to Trump. It's not like he's done things to help anyone outside of his base since being elected. All he's done is cut a bunch of red tape to help businesses (and destroy the Earth... and stifle science... and try to remove oversight and accountability... and crush a free, private internet.. and on and on). Failed on his ban, can't get money for his wall, whiffed on healthcare reform... Basically a bunch of EOs and no solid legislation thus far.

 

But I digress. I appreciate the sentiment that we're getting screwed and others aren't by virtue of their lot in life.

 

Noticed this today:

 

 

That would be a bad deal for the ACA. It may be headed that way, especially if the new administration does nothing to help the ACA (they won't). So maybe we'll end up getting stuck with AHCA 2.0 anyway and those primarily sweating the costs will get their wish.

[JJ Husker]

 

 

So cost is more important an issue than citizens being protected El Diaco? Not poking the bear - just looking for clarity. I think perhaps the priorities of these two issues may be different depending on perspective (and sadly maybe party lines to some extent).

 

IMO I believe it is more important. The whole deal has to be sustainable for any of it to work long term. The cost problem is bad enough that it simply cannot be ignored. I do not believe party lines are affecting my outlook at all because there is currently no party I even remotely agree with.

 

I will acknowledge that a lot of my opinion comes from my personal experience (imagine that...). I make a decent living but even at that it is a struggle to pay for health insurance and healthcare. Premiums run me about $20,000 per year and this previous year 2 of us hit our max out of pockets so that is another $11,000 +/- in expenses. Mine maxed out on basically just routine care and a colonoscopy. I make too much to get any help with the premiums or to be able to deduct any costs on my tax return. There are many people in the same boat who make even less than I do but get no subsidy and do not meet the threshold for deducting costs. Yeah, it would be worse if I could not get coverage at all due to pre-existing conditions or if my income were poverty level and I wasn't able to afford it at all but the current system really only works without strain for those in the top 2% or 3% of income. Maybe I happen to be in some freak income bubble but it sure seems like healthcare and health insurance expenses should not be the only difference between being financially very comfortable or being broke. I cannot believe this system is working very well for anybody that makes less than $150K or $200K per year. Isn't that most everybody? Or possibly I'm getting old and $150,000+/- just isn't what it used to be. I don't think it is reasonable that, if a person/family has one or two routine medical issues, it should consume 25% to 100%+ of their yearly income. In my mind, that makes the cost issue even more imperative than securing free coverage for a few more people who are still going to go broke if they have any medical issues.

 

Totally understand - I've been accused of being too optimistic and blind to the negatives (in life in general - which usually results in me being deeply disappointed), so I guess my pipe dream is that we've (as a whole) avoided putting people in situations where they're totally screwed by not being prepared. And those of us who are better off have the obligation to step up and do more for those who have less.

 

I've certainly seen some of my out of pocket costs go up, but chalked that up to my increasing health issues and thinking that that's kinda going to be the case as I grow older. (and honestly the ACA gave me some comfort as I grow older that I'd have help if needed). For me the benefit of basic routine stuff being covered has been a cost savings (annual physicals etc) so it's basically been a wash.

 

I work in the healthcare field, and can say that I see a benefit with patients who otherwise would be going to the ER only when things were critical (or worse, using the ER for basic healthcare and taking that resource away from someone who needs urgent care). I think that the long term benefit from having more people being covered won't be seen for many, many years. And right now nobody is able to show that as a tangible.

 

Cost is something that needs to be acknowledged, I just don't think it was the main goal of the initial action of putting the ACA in place - getting care to those without it was step one.

 

 

They were both issues that needed to be addressed for sure. Maybe access WAS the more important first thing.... I'm sure it was for the people who can now get coverage. But without reversing the costs trend I believe long term (big picture) those improvements will only be temporary and we're going to end up back where we were very quickly with an even bigger, harder to solve problem. It may very well be that it was necessary to get more people used to the idea that healthcare is more of a right than a luxury but we still have an extremely serious problem IMO. I hate to be alarmist but it really is something I believe we have days or months to fix and not years. Unfortunately our government has proven to not be up to the challenge nor do I believe they even really want to fix it. Quite possibly our government is what needs to be fixed next before true healthcare reform will be possible.

[JJ Husker]

I can't pretend to follow the thought train from "Washington is squeezing the middle class" to Trump. It's not like he's done things to help anyone outside of his base since being elected. All he's done is cut a bunch of red tape to help businesses (and destroy the Earth... and stifle science... and try to remove oversight and accountability... and crush a free, private internet.. and on and on). Failed on his ban, can't get money for his wall, whiffed on healthcare reform... Basically a bunch of EOs and no solid legislation thus far.

 

But I digress. I appreciate the sentiment that we're getting screwed and others aren't by virtue of their lot in life.

 

Noticed this today:

 

 

That would be a bad deal for the ACA. It may be headed that way, especially if the new administration does nothing to help the ACA (they won't). So maybe we'll end up getting stuck with AHCA 2.0 anyway and those primarily sweating the costs will get their wish.

 

I'm not sure what you're saying here on two accounts.

 

1- The middle gets squeezed because they are the ones paying taxes and paying their own bills. The rich don't pay their fair share of taxes and paying their own bills is easy. The poor pay little to nothing in taxes and pay little to nothing for many things that get subsidized by tax dollars. Maybe I misunderstood and this isn't the "thought train" you were failing to connect but it seems overly obvious to me.

 

2- I would be one of those primarily sweating the costs and the AHCA, 2.0 or otherwise, is not on my wish list. Expressing the desire that things get fixed does not equate to thinking the AHCA was a good or better deal. I'm glad it didn't happen, it would've made things much worse for everyone except the rich and big business. At least the ACA helped some on the lower end.

[Danny Bateman]

 

I can't pretend to follow the thought train from "Washington is squeezing the middle class" to Trump. It's not like he's done things to help anyone outside of his base since being elected. All he's done is cut a bunch of red tape to help businesses (and destroy the Earth... and stifle science... and try to remove oversight and accountability... and crush a free, private internet.. and on and on). Failed on his ban, can't get money for his wall, whiffed on healthcare reform... Basically a bunch of EOs and no solid legislation thus far.

 

But I digress. I appreciate the sentiment that we're getting screwed and others aren't by virtue of their lot in life.

 

Noticed this today:

 

 

That would be a bad deal for the ACA. It may be headed that way, especially if the new administration does nothing to help the ACA (they won't). So maybe we'll end up getting stuck with AHCA 2.0 anyway and those primarily sweating the costs will get their wish.

 

I'm not sure what you're saying here on two accounts.

 

1- The middle gets squeezed because they are the ones paying taxes and paying their own bills. The rich don't pay their fair share of taxes and paying their own bills is easy. The poor pay little to nothing in taxes and pay little to nothing for many things that get subsidized by tax dollars. Maybe I misunderstood and this isn't the "thought train" you were failing to connect but it seems overly obvious to me.

 

2- I would be one of those primarily sweating the costs and the AHCA, 2.0 or otherwise, is not on my wish list. Expressing the desire that things get fixed does not equate to thinking the AHCA was a good or better deal. I'm glad it didn't happen, it would've made things much worse for everyone except the rich and big business. At least the ACA helped some on the lower end.

 

 

What I was getting at is that I fear for the nature of our healthcare system if they do indeed just let the ACA destabilize and do nothing. Neither of us were at all impressed with their first crack at it, and they had 7 years. I'm not looking forward to what we get if they get a chance at a reboot. I fear the far-right getting a foothold to push for things like eliminating pre-existing conditions protections or sabotaging Medicaid. My primary consideration here is a healthcare system that is accessible by as many people as possible. If we do it right, I think we get universal coverage that is also great for cost control.

 

I'm worried they'll take a gung-ho market based approach that is too lopsided that could lead to a race to the bottom offering extremely cheap insurance plans that are more or less useless while also making things that the GOP ideologically opposes, on either religious or fiscal grounds, prohibitively expensive - like birth control, mental health coverage, substance abuse, maternity leave - because no insurer wants to be the one that has to offer those more expensive coverages.

I think the ACA definitely took a step towards making the rich pay more. Things like capping insurance CEO salaries or the 0.9% Medicare Tax on the upper tax brackets certainly tried to address that end of the issue. As to the poor not paying into anything - that's certainly an argument one can make. It's not one I share, but that's ok. It's a relatively minor quibble to have. I heard a podcast recently where it was suggested that if Democrats could have another 2009 and second shot at the ACA, they'd simply try to be more bold and just make the rich pay for it. That's a distinctly socialist approach, but I much prefer it to the alternative, and I wonder how much different the ACA itself would be if the Dems hadn't concerned themselves with trying to make concessions to the Republicans.

 

My overall point was just that I appreciate the improvement that the ACA has made. I've been one of the "winners," I guess.

[zoogs]

I don't really disagree but, if you remove the humanity aspect, all it really accomplished was funneling more tax payer dollars to insurers, pharma and healthcare providers.

...and to people who can't otherwise get coverage. You mention this yourself, so this part of your statement seems out of place.

 

The ACA is more of a downward distribution of income than it is not, no? As for the relative beneficiaries, it's more that they weren't disrupted -- because they felt they needed the insurers on board -- than it is that they got a handout, or am I mistaken?

[JJ Husker]

 

I don't really disagree but, if you remove the humanity aspect, all it really accomplished was funneling more tax payer dollars to insurers, pharma and healthcare providers.

...and to people who can't otherwise get coverage. You mention this yourself, so this part of your statement seems out of place.The ACA is more of a downward distribution of income than it is not, no? As for the relative beneficiaries, it's more that they weren't disrupted -- because they felt they needed the insurers on board -- than it is that they got a handout, or am I mistaken?

I don't view it necessarily as a downward distribution income (even though that is some of what it did) because that was/is a problem that needed addressed. I see it primarily as something that allowed costs to continue to increase and rather as just another upward distribution of income. I mean really, in total dollars, who is still benefitting the most? Insurers, pharma, healthcare providers and politicians, that's who.

 

I'm not upset that some uninsured people were able to acquire coverage or even that the cost is primarily being born by the middle. I guess I'm just pissed they didn't do more with the ACA and really pissed that this latest ACHA fiasco was just a blatant attempt at even further upward distribution and to destroy the gains of the ACA. A little disillusioned I guess. If the dems didn't fix it and the Repubs don't even want to try, who in the bloody hell is going to fix it?

[zoogs]

I think the operative word is "still". I agree that even more disruption to the status quo would have been desirable. I'm fairly sympathetic to criticisms that they weren't bold enough. However, I also think there's a strong argument on the other side that they couldn't have compromised much less than they did. The Republicans had the votes and couldn't get it done this time. Holding seats isn't sufficient if all the major players line up on the other side. Enough of them did with the ACA as was to inspire the Tea Party movement, the six-year backlash, and the 2016 election.

 

I don't know how history will view Obamacare, or the Hillary/Sanders debate on how to proceed. It's quite possible we'll eventually all be a little ticked they didn't strike harder while the iron was hot. I just don't think it's possible to achieve anything without compromise, and in this case that means managing to get big industry players on board with dismantling their own power.

 

Another analogy I wanted to offer up: walking before you run. I'm as annoyed as anyone that we aren't running yet, and maybe we could've started both at the same time, but we're walking so let's build on that.

[NM11046]

[commando]

thats a heck of a tweet for april 1st