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Repealing the ACA under Trump


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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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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.

 

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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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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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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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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.

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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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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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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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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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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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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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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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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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