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Optimist
01-24-2017, 12:47 AM
Because there are still not enough young, healthy people buying into it to offset the costs of the poor and sick. (Don't get me wrong I really believe in helping the less-fortunate but Obamacare isn't helping things.)

Now y'all know I usually try to stay out of these things..but I'm gonna stick my 2 cents in this time and then leave you to it. The craziness is that they expected young people to just comply with ACA and buy. What they didn't count on was the fact that wages are so squelched for new hires, privatized loans/tuition is so high, and employment even for college grads is so spotty, that there was no way that was going to happen. We talk about it at work from time to time and even though we can afford it, Nooooobody feels good about spending $4,5,600 a month on coverage! We're all healthy as horses, which is a big reason why we can do this job, so many of us are throwing premiums away, unless we have children or a chronic illness. Our state could give a shit, so we don't have a lot of great plans to choose from like some in the rest of the country. I've been tempted to use my old address of a relative's home in another state just so I could cut my costs in half. But I don't want to get caught doing it.
Anyway, if you've seen the headlines on how the last Administration made...errors...in counting the loan repayment default rate and errors in counting the chronically unemployed, then you know ACA was doomed. OAN,doctors are getting only about 50% reimbursement for Medicare procedures so many in private practice are opting out, dumping patients left and right. I don't know about y'all but I'm moving to CANADA! smh

Optimist
01-24-2017, 01:03 AM
2. Doctors will have to cut their pay by essentially agreeing that the lowest reimbursement rate is all they will ever get. Essentially doctors will engage in a race to the bottom on rates. Anytime an insurer negotiates a lower rate, all rates fall to that new low. It's called competition. Unbirdled, free market competition.

3. Pharmaceutical companies need some patent protection on new medications to encourage development. They will get seven years. But, after that, all their work becomes public domain and can be copied by anyone with a pharmaceutical license. The FDA will have to stop protecting big pharma and start approving procedures, techonologies and medications quickly. Any procedure, technology or medication approved in western europe, Canada, or Japan shall be automatically approved in the U.S.A.

HTH
Z

In defense of doctors, their insurance is outrageous. That's a big part of why they charge so much. But Big Pharma charges those inflated prices to us because Congress allows them. So their control of Congress would have to end to get fair pricing.

Zofia
01-24-2017, 05:41 PM
In defense of doctors, their insurance is outrageous. That's a big part of why they charge so much. But Big Pharma charges those inflated prices to us because Congress allows them. So their control of Congress would have to end to get fair pricing.

I guess you didn't read the first part of my message. Oh well.

Eric Stoner
01-26-2017, 08:28 AM
In defense of doctors, their insurance is outrageous. That's a big part of why they charge so much. But Big Pharma charges those inflated prices to us because Congress allows them. So their control of Congress would have to end to get fair pricing.

That is PART of the problem. Malpractice insurance is just one expense. So is liability insurance if the doctor owns the building or shares costs.
Then there is student loan repayment and the doctor's own payroll including possibly ... health care for her or his employees.

Why are malpractice premiums so high ? Well 2/3 of the malpractice ( some studies say 75 % ) is committed by foreign trained doctors. 3/4 of malpractice cases that actually go to trial result in defense verdicts. Another big chunk is the cost of defense. It is the defense lawyers who are the ones really getting rich.

Here's another problem : A lot of lawsuits are brought because something went wrong and the hospital or nursing home won't tell the family ,loved ones , survivors what happened. A lawsuit is the only way to find out what happened to a loved one because the risk managers , lawyers and sometimes even the laws in various states tell the hospitals not to say. Or permit them not to say. Elderly and /or sick patients fall down and get hurt all the time. Sometimes they get seriously injured and even die but nobody wants to say what happened. Operations go awry even though everyone followed good and accepted practices but the "cone of silence " descends rather than explain to the family what , if anything , went wrong.

Another biggie is infection. The best place to catch a disease or get an infection is a hospital. There are so many things they could be doing to improve infection rates but most do not want to spend the extra money.

Many doctors still think that they alone do not have to wash their hands ! Read the studies. It is ridiculous. It's like they never learn. They love to tell everyone else to do it.

eagle2
01-26-2017, 09:04 AM
European hospitals take much more precautions than American hospitals to prevent infections.

Eric Stoner
01-26-2017, 11:04 AM
European hospitals take much more precautions than American hospitals to prevent infections.

I think you mean Western Europe i.e. Britain , Scandinavia , the Benelux countries, Germany and France. Eastern Europe , for the most part , is worse than the U.S. So are Spain , Portugal and Greece. Italy is pretty good. The Swiss are fantastic.

baer45
01-31-2017, 12:43 PM
hmm... Trump seems all business now.

http://www.cnbc.com/2017/01/31/trump-to-meet-pharmaceutical-representatives-at-white-house-on-tuesday.html

Trump to meet pharmaceutical representatives at White House on Tuesday

U.S. President Donald Trump, who has criticized the high prices of prescription drugs, will meet with representatives of the pharmaceutical industry on Tuesday at the White House, the White House said in a statement.

baer45
05-04-2017, 04:32 PM
I just read all the details about new "Plan" that Trump authorized...and surely republicans (lobbists lay those doc on his desk) pushed it hard. Trump, you fucking idiot, this is going to fail. The new replacement falls back to the old route: not touching : pharmaceuticals, doctors, hospitals, and insurance companies.

In the U.S. health care system, everything costs more. Being in a hospital cost more. Because our drugs cost more (prescription drug prices can be 10X the rate in the UK or Germany). And our doctors cost more (a US family physician makes 3X her German counterpart).

Some people, not all of us, will get screwed. Trump, you dropped the ball there and you are a fucking idiot!

eagle2
05-04-2017, 10:11 PM
Trump has sexually assaulted women on multiple occasions, stolen millions of dollars from contractors and employees by not paying them for their services, scammed working-class Americans with his fake university, and sells products made in Chinese sweatshops. What made you think that he could care less about the average American?

Rispy_Girl
05-04-2017, 10:28 PM
I just read all the details about new "Plan" that Trump authorized...and surely republicans (lobbists lay those doc on his desk) pushed it hard. Trump, you fucking idiot, this is going to fail. The new replacement falls back to the old route: not touching : pharmaceuticals, doctors, hospitals, and insurance companies.

In the U.S. health care system, everything costs more. Being in a hospital cost more. Because our drugs cost more (prescription drug prices can be 10X the rate in the UK or Germany). And our doctors cost more (a US family physician makes 3X her German counterpart).

Some people, not all of us, will get screwed. Trump, you dropped the ball there and you are a fucking idiot!

Then move to Germany.

Also a doctor I know who is from Canada and who's mom lives there responds to the Canada comparison saying that 1) doctors don't make shut there and 2) mentioning how long you normally have to wait and how far you have to go for treatments. Essentially the same problems that exist with VA stuff.

We have (had and hopefully will have again) it damn good in the US. If you oppose capitalism and competition you can go somewhere with single payer health care. The place you live doesn't need to change just because you think the alternative is better. Some people choose to be here because of what's already here.

eagle2
05-04-2017, 11:14 PM
Not that I'm advocating single payer healthcare, but single payer doesn't mean there isn't any competition or capitalism. You still have the option of choosing the doctor or hospital you go to, and most hospitals and doctor practices are privately run. Most seniors in the US are on single payer.

I want to see universal coverage in the US, but I don't have a problem if it's done through private insurance. Switzerland has everyone covered through private insurance and their system seems to be working well.

Eric Stoner
05-10-2017, 10:42 AM
Not that I'm advocating single payer healthcare, but single payer doesn't mean there isn't any competition or capitalism. You still have the option of choosing the doctor or hospital you go to, and most hospitals and doctor practices are privately run. Most seniors in the US are on single payer.

I want to see universal coverage in the US, but I don't have a problem if it's done through private insurance. Switzerland has everyone covered through private insurance and their system seems to be working well.

Switzerland has a small , very affluent , very well educated population. The U.S. has a large , diverse population. I don't think a cookie cutter , one size fits all approach will work.

Imperfect though the HOUSE plan may be, it is NOT the finished product. Trump had nothing to do with it. He hasn't signed it because there is nothing passed yet. The Senate is going to pass their version , then it will go to Conference and we will see what if anything both houses can agree on.

The fact remains that the current situation is out of control, Less choice : Insurers are leaving states making for less competition. Some are not writing health insurance at all.Deductibles and premiums have both increased and are increasing.

To the critics of the Republican Repeal and Replace ; Repair and Reform ; call it what you want : Your alternative is WHAT ? More of the same ? Even higher premiums and deductibles ? Increased penalties on healthy young folks NOT buying insurance.

As long as we are on the subject - Does anyone know and understand the argument for the current prohibition on crossing state lines to buy health insurance ? If New Jersey has better and cheaper coverage then why can't I buy a policy there or from a New Jersey insurer ?

Zofia
05-10-2017, 06:23 PM
The fact remains that the current situation is out of control, Less choice : Insurers are leaving states making for less competition. Some are not writing health insurance at all.Deductibles and premiums have both increased and are increasing.

Exactly right, Eric.


To the critics of the Republican Repeal and Replace ; Repair and Reform ; call it what you want : Your alternative is WHAT ? More of the same ? Even higher premiums and deductibles ? Increased penalties on healthy young folks NOT buying insurance.

That is the central problem of Obama care. Premiums go up and up because there is no way to price plans for younger and healthier consumers. Either prices go up, or the carrier exits the market. For as smart as people claim he was, Obama never really seemed to learn micro and macro economics in college.


As long as we are on the subject - Does anyone know and understand the argument for the current prohibition on crossing state lines to buy health insurance ? If New Jersey has better and cheaper coverage then why can't I buy a policy there or from a New Jersey insurer ?

Good question. All I can think of is the interstate commerce clause and the tenth amendment. But, those really seem to regulate the federal government, not the states.

Z

eagle2
05-10-2017, 06:47 PM
Switzerland has a small , very affluent , very well educated population. The U.S. has a large , diverse population. I don't think a cookie cutter , one size fits all approach will work.

Imperfect though the HOUSE plan may be, it is NOT the finished product. Trump had nothing to do with it. He hasn't signed it because there is nothing passed yet. The Senate is going to pass their version , then it will go to Conference and we will see what if anything both houses can agree on.


Trump has been pushing this legislation probably harder than anyone. Obama didn't have too much to do with writing 'Obamacare'. It was mostly done by Congress, but he is the one most associated with it, because he pushed for it and signed it.



The fact remains that the current situation is out of control, Less choice : Insurers are leaving states making for less competition. Some are not writing health insurance at all.Deductibles and premiums have both increased and are increasing.

To the critics of the Republican Repeal and Replace ; Repair and Reform ; call it what you want : Your alternative is WHAT ? More of the same ? Even higher premiums and deductibles ? Increased penalties on healthy young folks NOT buying insurance.

Most Americans haven't been seriously affected by Obamacare. Most Americans get their health insurance through their employer or the government. The 20 - 30 million Americans who get insurance through Obamacare, that didn't have insurance before are much better off. The ones most likely to have seen a negative effect would be people buying health insurance for themselves, who do not qualify for any subsidies.

There are fixes that can be put in place that would reduce the large increases we recently saw. In Alaska, premiums were set to increase 42 percent. Alaska’s insurance commissioner implemented adjustments that reduced the increase from 42 percent to 7 percent.

https://www.vox.com/policy-and-politics/2017/4/13/15262614/obamacare-alaska-reinsurance

If other states made similar adjustments, they could probably also reduce the premium increases we've been seeing. Also, if every state expanded Medicaid, there would be lower increases, because there would be fewer uninsured people going to hospitals that aren't able to pay their bills, in which case the costs are passed on to those patients who are insured. Nobody is saying Obamacare is perfect, but there is a lot that can be done to improve it, rather than throwing it away. The current 'healthcare' bill isn't even a healthcare bill. It's more of a tax cut bill for wealthy Americans that is paid for by cutting government spending on healthcare.



As long as we are on the subject - Does anyone know and understand the argument for the current prohibition on crossing state lines to buy health insurance ? If New Jersey has better and cheaper coverage then why can't I buy a policy there or from a New Jersey insurer ?

Because if that were to happen, all insurers would move to the state with the weakest regulations. Some states do allow residents to purchase insurance across state lines. Allowing people to purchase health insurance from other states wouldn't do much to reduce insurance costs, because most out of state insurers would not have doctor and hospital networks set up in that state.

rickdugan
05-11-2017, 07:06 AM
^ Alaska has less than 800,000 people and only 14,000 of them on the individual exchanges. Alaska also collects more tax revenue per capita than almost any other state because of money they collect from oil and gas producers. So it wasn't much of a burden for them to agree to reimburse insurance companies for larger claims submitted in the individual marketplace. But even with the additional state subsidy that may end up being passed off onto the federal government, insurance premiums in Alaska are still way too high (among the worst in the nation and that is saying something). This was a band-aid where triage was needed, nothing more. I somehow doubt that many states with larger exchange enrollment are going to be as eager to put themselves on the hook for potentially large medical bill payments.

As far as purchasing across state lines, I actually agree that this may not be an instant fix, but not for the reasons outlined above. Many of the larger insurance carriers already have provider networks in many U.S. states, just under different legal subsidiaries. The problem as I see it is that economies of scale are difficult to achieve when each carrier has to comply with a patchwork of 50 different sets of insurance regulations. Any fix would have to include streamlining regulatory requirements, which I am not sure would even be constitutional.

Finally, as far as this comment: "The ones most likely to have seen a negative effect would be people buying health insurance for themselves, who do not qualify for any subsidies.", I fall squarely in that category and I can tell you point blank that this is hurting a lot of small business owners, other entrepreneurs and others who do not want corporate employment. Do we not matter? ;) More importantly though, there just aren't enough of us to bend over the table to make these insurance premiums palatable vs. paying the penalties, so now the exchanges are full of sick people and the insurance companies are bleeding money - the few that are left anyway.

At the end of the day, Obamacare is just too structurally flawed to work because it relies on too few healthy people to subsidize too many sick ones. To have a chance of making it work in anything remotely close to its current form, you would have to either dramatically increase government subsidization or dramatically increase the pool of people covered by these policies. Since I do not believe that the political will exists to do either (and I am including both parties in this), the only viable approach IMHO is to scrap Obamacare and replace it with something more manageable.

Eric Stoner
05-11-2017, 08:30 AM
^^^^
1. Another one bites the dust. Aetna , one of the largest health insurers is following the lead of many other insurers and is leaving the Exchanges. Plus they will no longer write policies in Delaware and Nebraska.

2. Eagle - I cannot understand how you can say that "Most Americans have not been affected by Obamacare". Employers have cut payrolls to stay under Employer mandates and /or have converted millions of full time workers to part-time. Many younger people ( the ones Obamacare NEEDS to buy coverage to help pay for the sick , old etc. ) have decided that it is CHEAPER to pay the IRS penalties than to buy coverage that they do not need. How many men do you know who need coverage for breast pumps and pre-natal care. NO ! I didn't toss that in for a cheap laugh. It is a major problem with carriers issuing cookie cutter policies mandated by regulators and forcing people to buy coverage that they simply do not need. Yes, most Americans still get coverage from their employers , both in the public and private sector. But as Mr. Dugan has pointed out that still leaves millions of people ( like my employees ) who work for small businesses and whose employers cannot afford to pay for their health insurance. I can and do but I have made it clear to my employees that the costs of providing them coverage which keeps going up , A LOT , is why they didn't get raises the last two years and won't be getting one this year.
And how about all the people who liked their plan , were told they could keep their plan but could not ? Or those who liked their doctor, were told they could keep their doctor but found out they had to switch to another doctor. THAT one I am very familiar with. A few years ago I had to pay my PCP out of my own pocket to keep seeing him. My carrier assigned me to some guy I didn't know , had never heard of and whose office was further away. After about a year I was able to upgrade my coverage and go back to being able to see my preferred doctor.

3. I am old enough to remember when Nixon proposed National Health Insurance whereby those too poor to pay for their own coverage and who didn't get coverage from their employer or Medicaid would have had their premiums subsidized. Ted Kennedy sheepishly admitted ( about 20 years after the fact ) that he didn't support Nixon's proposal and came up with bullshit opposition because he couldn't stand Nixon and refused to let him have a political victory. After Hillary-Care crashed and burned with ZERO votes in the Senate , Teddy admitted that he was wrong and should have helped Nixon pass his plan. Point being that it was a good idea then and it is still a good idea to help those who cannot afford health insurance pay for it. In fact we could abolish Medicaid which is bankrupting half the states and replace it with subsidized private insurance.

4. The prohibitions on portability and purchase of insurance across state lines make ZERO sense. Especially when as now , some states have a grand total of ONE insurance company writing health insurance .

5. Who has been helped by Obamacare ? Who is better off NOW compared to BEFORE Obamacare ? It's not the doctors who are bailing out on taking ANY insurance. In droves. Many will not take Medicaid or even Medicare because the payments are too low. It's not Medicaid recipients who have seen their availability and quality of care go DOWN under Obamacare. It's not the insurance companies who are bailing out of health insurance as fast as they can. Name one , just ONE new health insurance company since Obamacare that is NOT state created or state subsidized.

6. Why is that hospital in Oklahoma able to do surgeries so cheaply when they refuse to take any insurance ? They are doing operations for half to a quarter of what other hospitals charge , with BETTER outcomes. So much so that people are traveling to Oklahoma for elective surgery. Why else would anyone go to Oklahoma lol ? Part of the answer is that they do not have to hire people to deal with insurance companies , Medicaid and Medicare. There are people that go there and then get reimbursed , at least in part for the costs. Why are we not seeing more duplication ?

7. There are still MILLIONS of people in this country who get medical care but do not have coverage. The politics ban on this board prevents me from describing the status of many of them but even they are only part of the problem. In NYC the Health and Hospitals Corporation ( that runs the public hospitals ) is laying off hundreds of workers.

My point is that Obamacare took a bad situation and made it WORSE. Either we rely on the private sector to cover people ( with subsidies for those who can't afford the premiums ) or we bite the bullet and go to a single payer system with everything that comes with it. Both good and bad. Personally I prefer private enterprise with the resultant experimentation and innovation to control costs. I want to see a plan that opens and expands the market for coverage. As I have posted before , I am old enough to remember a time when consumers could shop for coverage that suited them best. For example, you used to be able to buy a policy that only covered you for hospitalization and you had to pay for doctor visits and the like out of your own pocket.

Why not treat pre-existing conditions the way auto insurers used to treat high risk drivers ? An "assigned risk " pool was set up and each carrier had to take their proportionate share and cover them.

So far , all I have heard from Obamacare supporters amounts to putting new tires on the same broken down jalopy. I acknowledge that something had to be done to help more people get coverage but Obamacare seems to be the worst of all worlds.

Ifyouseekamy
05-11-2017, 11:35 PM
Everyone is pulling out of the Iowa market next year. Not sure what I will do

Eric Stoner
05-12-2017, 09:09 AM
Everyone is pulling out of the Iowa market next year. Not sure what I will do

A number of states have ZERO private insurers. And with Aetna ceasing operations in Nebraska and Delaware ; with other states that will have ZERO insurers next year , your ONLY alternative will be the state created insurance company.

baer45
05-12-2017, 10:59 AM
A number of states have ZERO private insurers. And with Aetna ceasing operations in Nebraska and Delaware ; with other states that will have ZERO insurers next year , your ONLY alternative will be the state created insurance company.
California is trying to pass a bill to ban all the private insurers conduct business in CA. We will see how it turns out

Nyla19
05-12-2017, 11:02 AM
Then move to Germany.

Also a doctor I know who is from Canada and who's mom lives there responds to the Canada comparison saying that 1) doctors don't make shut there and 2) mentioning how long you normally have to wait and how far you have to go for treatments. Essentially the same problems that exist with VA stuff.

We have (had and hopefully will have again) it damn good in the US. If you oppose capitalism and competition you can go somewhere with single payer health care. The place you live doesn't need to change just because you think the alternative is better. Some people choose to be here because of what's already here.

And what's funny is that the people who are so pissed about their insurance premiums vote for politicians that make it even worse. This really is a country full of dunces.

eagle2
05-12-2017, 11:24 PM
^ Alaska has less than 800,000 people and only 14,000 of them on the individual exchanges. Alaska also collects more tax revenue per capita than almost any other state because of money they collect from oil and gas producers. So it wasn't much of a burden for them to agree to reimburse insurance companies for larger claims submitted in the individual marketplace. But even with the additional state subsidy that may end up being passed off onto the federal government, insurance premiums in Alaska are still way too high (among the worst in the nation and that is saying something). This was a band-aid where triage was needed, nothing more. I somehow doubt that many states with larger exchange enrollment are going to be as eager to put themselves on the hook for potentially large medical bill payments.

As far as purchasing across state lines, I actually agree that this may not be an instant fix, but not for the reasons outlined above. Many of the larger insurance carriers already have provider networks in many U.S. states, just under different legal subsidiaries. The problem as I see it is that economies of scale are difficult to achieve when each carrier has to comply with a patchwork of 50 different sets of insurance regulations. Any fix would have to include streamlining regulatory requirements, which I am not sure would even be constitutional.

Finally, as far as this comment: "The ones most likely to have seen a negative effect would be people buying health insurance for themselves, who do not qualify for any subsidies.", I fall squarely in that category and I can tell you point blank that this is hurting a lot of small business owners, other entrepreneurs and others who do not want corporate employment. Do we not matter? ;) More importantly though, there just aren't enough of us to bend over the table to make these insurance premiums palatable vs. paying the penalties, so now the exchanges are full of sick people and the insurance companies are bleeding money - the few that are left anyway.

At the end of the day, Obamacare is just too structurally flawed to work because it relies on too few healthy people to subsidize too many sick ones. To have a chance of making it work in anything remotely close to its current form, you would have to either dramatically increase government subsidization or dramatically increase the pool of people covered by these policies. Since I do not believe that the political will exists to do either (and I am including both parties in this), the only viable approach IMHO is to scrap Obamacare and replace it with something more manageable.

Health insurance and medical care are probably more expensive in Alaska because of how remote it is and because it's sparsely populated. Alaska doesn't even have a medical school. Sarah Palin said her family used to sneak across the border to Canada for medical care.

http://thehill.com/blogs/blog-briefing-room/news/85435-palin-i-snuck-across-canadian-border-for-heatlhcare

I fully support making changes to make healthcare more affordable for people like you, who have to buy insurance on the open market. The best way would be to have everyone pay into the system so there aren't a disproportionate amount of unhealthy people buying insurance. Maybe increase the penalty for not buying insurance and/or increase subsidies. Switzerland has something similar to Obamacare, but they have much stiffer penalties for people who don't buy insurance, so most people do. Also cutting down on administrative costs. What I'm against is taking health insurance away from 20 - 30 million people.

eagle2
05-13-2017, 12:55 AM
^^^^
1. Another one bites the dust. Aetna , one of the largest health insurers is following the lead of many other insurers and is leaving the Exchanges. Plus they will no longer write policies in Delaware and Nebraska.

2. Eagle - I cannot understand how you can say that "Most Americans have not been affected by Obamacare". Employers have cut payrolls to stay under Employer mandates and /or have converted millions of full time workers to part-time. Many younger people ( the ones Obamacare NEEDS to buy coverage to help pay for the sick , old etc. ) have decided that it is CHEAPER to pay the IRS penalties than to buy coverage that they do not need. How many men do you know who need coverage for breast pumps and pre-natal care. NO ! I didn't toss that in for a cheap laugh. It is a major problem with carriers issuing cookie cutter policies mandated by regulators and forcing people to buy coverage that they simply do not need. Yes, most Americans still get coverage from their employers , both in the public and private sector. But as Mr. Dugan has pointed out that still leaves millions of people ( like my employees ) who work for small businesses and whose employers cannot afford to pay for their health insurance. I can and do but I have made it clear to my employees that the costs of providing them coverage which keeps going up , A LOT , is why they didn't get raises the last two years and won't be getting one this year.


Employees have not cut payroll. Obamacare went into effect in 2014. 2014 saw the America's best year of job growth since 1999. http://money.cnn.com/2015/01/09/news/economy/december-jobs-report-unemployment/

Also, the number of full-time employees is way up.
https://www.statista.com/statistics/192356/number-of-full-time-employees-in-the-usa-since-1990/

If anything, Obamacare has created jobs. Hiring in the healthcare industry has gone up since Obamacare went into effect.
Small businesses with 25 or fewer employees get tax credits for providing health insurance.

4. The prohibitions on portability and purchase of insurance across state lines make ZERO sense. Especially when as now , some states have a grand total of ONE insurance company writing health insurance .

Some states passed laws allowing residents to purchase insurance across state lines, and it didn't make much difference in the cost of insurance. Again, insurance companies that aren't offering insurance in a specific state don't have doctor or hospitals in those specific states.

[QUOTE=Eric Stoner;2986842]^^^^
5. Who has been helped by Obamacare ? Who is better off NOW compared to BEFORE Obamacare ? It's not the doctors who are bailing out on taking ANY insurance. In droves. Many will not take Medicaid or even Medicare because the payments are too low. It's not Medicaid recipients who have seen their availability and quality of care go DOWN under Obamacare. It's not the insurance companies who are bailing out of health insurance as fast as they can. Name one , just ONE new health insurance company since Obamacare that is NOT state created or state subsidized.

I have not heard of anyone on Medicaid or Medicare that needs medical care but is unable to get it. I have heard of numerous cases of people without insurance who needed medical care but were unable to get it.

Many doctors and hospitals are better off now than before Obamacare. They are seeing far fewer patients that are unable to pay their bills. This is especially true in states that have expanded Medicaid. The approximately 25 million Americans who have insurance now as a result of Obamacare, but didn't have any insurance before are better off.

If nobody is better off now than before Obamacare, why is it that the majority of Americans are opposed to repealing it?


6. Why is that hospital in Oklahoma able to do surgeries so cheaply when they refuse to take any insurance ? They are doing operations for half to a quarter of what other hospitals charge , with BETTER outcomes. So much so that people are traveling to Oklahoma for elective surgery. Why else would anyone go to Oklahoma lol ? Part of the answer is that they do not have to hire people to deal with insurance companies , Medicaid and Medicare. There are people that go there and then get reimbursed , at least in part for the costs. Why are we not seeing more duplication ?

Many people can't afford surgery without insurance. Hospitals that get paid by insurance charge more than a hospital that gets paid in cash because in most cases insurance companies don't reimburse hospitals at 100 percent, so hospitals charge more knowing that insurers are only going to pay a certain percent of what they bill. Also, hospitals that have emergency rooms have to take in patients who don't have insurance and are not able to pay their bills, so they raise the price for insured patients to make up this difference. Obamacare has cut down the number of uninsured patients going to the emergency room.




7. There are still MILLIONS of people in this country who get medical care but do not have coverage. The politics ban on this board prevents me from describing the status of many of them but even they are only part of the problem. In NYC the Health and Hospitals Corporation ( that runs the public hospitals ) is laying off hundreds of workers.

There are far fewer people now who get medical care but do not have coverage than there were before Obamacare.



My point is that Obamacare took a bad situation and made it WORSE. Either we rely on the private sector to cover people ( with subsidies for those who can't afford the premiums ) or we bite the bullet and go to a single payer system with everything that comes with it. Both good and bad. Personally I prefer private enterprise with the resultant experimentation and innovation to control costs. I want to see a plan that opens and expands the market for coverage. As I have posted before , I am old enough to remember a time when consumers could shop for coverage that suited them best. For example, you used to be able to buy a policy that only covered you for hospitalization and you had to pay for doctor visits and the like out of your own pocket.

Then why are the majority of Americans opposed to repealing Obamacare? The 20 - 30 million people who have insurance now but not before are definitely not worse off. The doctors and hospitals that have seen a decline in unpaid bills aren't worse off.


Why not treat pre-existing conditions the way auto insurers used to treat high risk drivers ? An "assigned risk " pool was set up and each carrier had to take their proportionate share and cover them.

So far , all I have heard from Obamacare supporters amounts to putting new tires on the same broken down jalopy. I acknowledge that something had to be done to help more people get coverage but Obamacare seems to be the worst of all worlds.
Not for the people I mentioned above who are much better off now than before Obamacare went into effect.

baer45
05-13-2017, 07:02 AM
Then move to Germany.

Also a doctor I know who is from Canada and who's mom lives there responds to the Canada comparison saying that 1) doctors don't make shut there and 2) mentioning how long you normally have to wait and how far you have to go for treatments. Essentially the same problems that exist with VA stuff.

We have (had and hopefully will have again) it damn good in the US. If you oppose capitalism and competition you can go somewhere with single payer health care. The place you live doesn't need to change just because you think the alternative is better. Some people choose to be here because of what's already here.

Not even going to read it when you start your argument like that.

seashell
05-13-2017, 08:28 PM
Personally, I am moving to Europe on a long-term work visa, and I'm excited to have cheap healthcare. Last time I had to go to a clinic in Czech Republic, it cost the equivalent of $5 to see a doctor, as a foreigner with just a tourist visa. Even with insurance and a copay (and citizenship) in the US, I've paid anywhere from $25-$50 for the same care. When I didn't have insurance, in the US, I racked up a $3500 hospital bill that I'm still paying off... and that's nothing compared to the bills some people get stuck with. This is unheard of in most other countries. I love the US, but personally I'm happy to get out of this healthcare mess right now.

eagle2
05-13-2017, 10:50 PM
Most Americans I know of, who have had experience with other countries' healthcare systems, prefer the other country. Here's a comment from an American member of this forum who moved to Australia:


See, this is why you should all move to Australia. I'm always helped within half an hour and that one time something was wrong with my eyes, I was nearly thrown into the ER and looked at by 4 specialists.

Here's an article by an American who has spent approximately 20 years living in America and 20 years living in Britain:
http://www.businessinsider.com/an-american-uses-britain-nhs-2015-1

rickdugan
05-14-2017, 11:13 AM
Health insurance and medical care are probably more expensive in Alaska because of how remote it is and because it's sparsely populated. Alaska doesn't even have a medical school. Sarah Palin said her family used to sneak across the border to Canada for medical care.

http://thehill.com/blogs/blog-briefing-room/news/85435-palin-i-snuck-across-canadian-border-for-heatlhcare

I fully support making changes to make healthcare more affordable for people like you, who have to buy insurance on the open market. The best way would be to have everyone pay into the system so there aren't a disproportionate amount of unhealthy people buying insurance. Maybe increase the penalty for not buying insurance and/or increase subsidies. Switzerland has something similar to Obamacare, but they have much stiffer penalties for people who don't buy insurance, so most people do. Also cutting down on administrative costs. What I'm against is taking health insurance away from 20 - 30 million people.

As far as taking insurance away from 20-30 million people, that was a guesstimate based upon a complete Obamacare repeal. Nobody knows how many the current bill would affect, but I will say that creating slimmer policies without the bloated essential health benefits will encourage a lot more people to voluntarily buy insurance as it will inevitably bring down premiums. I mentioned earlier in this thread how much happier I was with a plan that was substantially cheaper with much better coverage for the things my family needed, which I lost the year that the new mandates kicked in. It did not cover pregnancies or mental health services, which was fine for us. I am eagerly waiting for the Senate to pass its own replacement option and for reconciliation to begin so that I may once again shop for a policy that is cheaper and provides better care for my family.

You keep bringing up Switzerland, but I think you are missing perhaps the most important distinction between Switzerland and Obamacare, which is that everyone in Switzerland must purchase insurance from the same market. They do not have the fractured health care market that we do, with Medicare, employer-provided insurance and Medicaid covering the vast majority of citizens. For this reason, your proposed fix will just not work because there just are not enough healthy and affluent people in the individual marketplace to subsidize the massive number of policies held by sick and/or subsidized participants. All the penalties in the world won't change that, but if you squeeze the relatively small number of us too hard through some combination of harsher penalties and more premium jackups, we will eventually disappear altogether by finding ways to enter the employer-sponsored market.

The only way this really has a chance or success - if you call the high premium high deductible policies that everyone in Switzerland must accept as "success" - is to force everyone on it, including those who are currently covered by employment-based plans. I strongly suspect that the architects of Obamacare were well aware of this weakness, but were too cowardly to risk alienating their union constituencies and instead pushed ahead with a flawed version that they could get passed. After all, it is far easier to try to screw over a relative small number of small business owners and other entrepreneurs than to try to tell the AFL-CIO, the United Federation of Teachers and various other unions that they were going to lose their excellent plans and instead be stuck with the crap that we get in the individual market. But this flaw is ultimately a fatal one and Obamacare cannot be saved without going after employee groups that neither party has the political will to touch. Shit, politicians on both sides are scared just to implement the Cadillac Insurance Tax, which will likely die a quiet death at some point in the future. They will never muster the will to take away these generous policies from unions and corporate employees altogether.

Now of course another route to saving Obamacare is to simply poor a massive amount of additional public funds into it, but I'm not sure that the political will exists to do that either as it could become a budget buster for both the Feds and the states.

So bye-bye Obamacare. I will not miss this atrocious insurance regimen one little bit. Obamacare created 3 classes of citizens, with first class receiving employer coverage and/or Medicare, the second class receiving subsidized individual policies with somewhat lower deductibles and premiums (but still higher deductibles than many poor could handle), and the third-class citizens, who were forced to take the crappiest policies with the highest premiums and deductibles in order to subsidize all of the second class citizens. I am one of those third-class citizens, as too are my wife and children. I cannot begin to express my ongoing anger at struggling to find a plan that our doctors would accept and paying $19,000 per year for what is little more than a catastrophic policy due to the high deductibles. If I could put on my pom poms and cheer in front of the Senate door, I would.

baer45
05-14-2017, 11:57 AM
Most Americans I know of, who have had experience with other countries' healthcare systems, prefer the other country. Here's a comment from an American member of this forum who moved to Australia:



Here's an article by an American who has spent approximately 20 years living in America and 20 years living in Britain:
http://www.businessinsider.com/an-american-uses-britain-nhs-2015-1

I had visited doctor's office in UK, Hongkong, Japan...I never had any unpleasent experience. Doctors were simply wonderful and very professional. Especially the one in Hongkong, the doctor patiently told me exactly what would happen in the next 6 hours after taking the pill and I could felt how much he cared. USA might have the best healthcare in the world if you can afford it...

I always believe the private practice should always have its place in USA. We should have basic public medical system and some part of the healthcare should be regulated by a department like SEC does for financial institutions. If you have extra income, you can afford better doctors, hospitals, you feel free to go "luxury" private hospital. But for the ones that can't afford the best doctors, they can go with the public healthcare system like other countries will do. I read a story online...someone's kid had infection in the eye. He called three doctors office and first two doctors all gave him a quot of $400+ medication plus the office visit cost, the last doctor gave him a $25 dollars medication plus the office visit copayment... Two medications are very similar but one is promoted by the doctors and pharms... He used the third doctor and his kid was treated properly. This is not right. In a better scenario, Under a regulation and doctors should be obligated to provide the cheaper medicine first (government regulated drugs, as public health system would do), then they can mention the expensive option to the patient. So the poor family could still get the medication they can afford. Not a professional in the medical field but that story is somehow annoying to me.

Eric Stoner
05-15-2017, 12:03 PM
Employees have not cut payroll. Obamacare went into effect in 2014. 2014 saw the America's best year of job growth since 1999. http://money.cnn.com/2015/01/09/news/economy/december-jobs-report-unemployment/

Also, the number of full-time employees is way up.
https://www.statista.com/statistics/192356/number-of-full-time-employees-in-the-usa-since-1990/

If anything, Obamacare has created jobs. Hiring in the healthcare industry has gone up since Obamacare went into effect.
Small businesses with 25 or fewer employees get tax credits for providing health insurance.
[QUOTE=Eric Stoner;2986842]4. The prohibitions on portability and purchase of insurance across state lines make ZERO sense. Especially when as now , some states have a grand total of ONE insurance company writing health insurance .

Some states passed laws allowing residents to purchase insurance across state lines, and it didn't make much difference in the cost of insurance. Again, insurance companies that aren't offering insurance in a specific state don't have doctor or hospitals in those specific states.


I have not heard of anyone on Medicaid or Medicare that needs medical care but is unable to get it. I have heard of numerous cases of people without insurance who needed medical care but were unable to get it.

Many doctors and hospitals are better off now than before Obamacare. They are seeing far fewer patients that are unable to pay their bills. This is especially true in states that have expanded Medicaid. The approximately 25 million Americans who have insurance now as a result of Obamacare, but didn't have any insurance before are better off.

If nobody is better off now than before Obamacare, why is it that the majority of Americans are opposed to repealing it?

Many people can't afford surgery without insurance. Hospitals that get paid by insurance charge more than a hospital that gets paid in cash because in most cases insurance companies don't reimburse hospitals at 100 percent, so hospitals charge more knowing that insurers are only going to pay a certain percent of what they bill. Also, hospitals that have emergency rooms have to take in patients who don't have insurance and are not able to pay their bills, so they raise the price for insured patients to make up this difference. Obamacare has cut down the number of uninsured patients going to the emergency room.



There are far fewer people now who get medical care but do not have coverage than there were before Obamacare.


Then why are the majority of Americans opposed to repealing Obamacare? The 20 - 30 million people who have insurance now but not before are definitely not worse off. The doctors and hospitals that have seen a decline in unpaid bills aren't worse off.

Not for the people I mentioned above who are much better off now than before Obamacare went into effect.

You insist on looking at just one side of the coin when it comes to Obamacare i.e. what I like to call Krugmanian Analysis : look only at the facts you like and that support your position. Ignore everything else or claim it doesn't exist.

"Employees have not cut payroll ". Obviously a typo but many employers have limited the number of their employees or converted full time to part time. Yes, overall unemployment is down but as we have repeatedly explained , to be counted as "employed" all one need do is work one hour in one month. The overall labor participation rate still stinks.

Maybe you should read the N.Y. Times and Washington Post more often. Both have documented the THOUSANDS of doctors who no longer take Medicaid patients or stopped taking new Medicaid patients. Same for Medicare.

You didn't answer my question. If things are as hunky and as dory as you say then you ought to easily be able to name all the new health insurers that started writing coverage after Obamacare came into effect. Excluding the state created companies. If not, why not ?

Americans are not opposed to repealing Obamacare per se. They are opposed to anything that reduces or jeopardizes their coverage. And who can blame them ?
They have gotten nothing but factually delinquent doom and gloom cost projections and coverage predictions.

You also have not even tried to explain the exorbitant premium increases that most Obamacare recipients have seen ; plus the insurers bailing out of exchanges and those who have stopped writing health insurance all together.

I am the first to say that the Pre-Obamacare situation was a mess. And it may be that the best way to go is a single-payer "Medicare For All " type system. But that would require some dramatic changes in our entire health care system. There will be a two-tiered system that will ignite the hair of all those currently wailing about income inequality. Then it will be health care inequality. One reason France has the relatively successful system that they do is that most people get most of their primary care from NON-doctors. France has medical officers much like our physician assistants and nurse practitioner. Especially for the poor and working class. And maybe that is a good thing.

baer45
05-15-2017, 01:58 PM
And that gives you an idea.



https://s12.postimg.org/kk0golmx9/highest-paying-job-in-each-state.jpg

lynn2009
05-15-2017, 03:49 PM
.........

baer45
05-15-2017, 05:00 PM
Is saving lives not a valuable skill?

Cops save lives...teachers give everyone a living skill...soldiers die for this country... and engineers build this world for us. Every job is valueable. Do America doctors do a 2x-3x better job than European or asian doctors?

add: I don't want to sound like I hate doctors or something. Pharmaceutical companies...medical equitment...everything is expensive, doctors are just part of it, probably a small piece of the pie.
Anyway I am really hoping to see CA be the experiment state of USA. If they push all the private insurance companies out and don't change anything about the medical cost... we will see how it goes. That will be interesting.

eagle2
05-15-2017, 09:24 PM
There are many things to take into consideration when determining how much doctors get paid. After graduating from a four year college or university, doctors go to medical school for another four years, where their average debt is around $200k when they finish. They then do a residency for 3 - 7 years before they start getting paid their high salary. After becoming medical doctors, on average, doctors work 60 hours a week.

eagle2
05-15-2017, 10:09 PM
You insist on looking at just one side of the coin when it comes to Obamacare i.e. what I like to call Krugmanian Analysis : look only at the facts you like and that support your position. Ignore everything else or claim it doesn't exist.

No I am not. My views are based on the facts. Yours are not. You don't agree with the law, so you're not willing to acknowledge anything other than Obamacare is a complete failure. You are stating things that aren't true. In a previous post you said:



2. Eagle - I cannot understand how you can say that "Most Americans have not been affected by Obamacare". Employers have cut payrolls to stay under Employer mandates and /or have converted millions of full time workers to part-time.

As I said before, Obamacare was implemented in 2014. Employers did not cut payrolls, they increased them. Approximately 2.95 million jobs were created in 2014. That is the exact opposite of your claim that employers cut payrolls. Not only that, the number of full time jobs increased by approximately 2.8 million. That is the exact opposite of your claim that employers have converted millions of full-time workers to part-time. It seems your statements are based on what you think would happen as a result of the law, not the actual facts. Again, approximately 2.95 million jobs were created in 2014 and the number of full-time workers increased by approximately 2.8 million. These are facts.




"Employees have not cut payroll ". Obviously a typo but many employers have limited the number of their employees or converted full time to part time. Yes, overall unemployment is down but as we have repeatedly explained , to be counted as "employed" all one need do is work one hour in one month. The overall labor participation rate still stinks.

I never said anything about unemployment. I only stated the number of jobs created and the increase in number of full-time workers. Again the increase in both was in the millions. Employers did not cut back on employees or full-time workers.




Maybe you should read the N.Y. Times and Washington Post more often. Both have documented the THOUSANDS of doctors who no longer take Medicaid patients or stopped taking new Medicaid patients. Same for Medicare.

What difference does that make, if everyone on Medicare and Medicaid is able to get the medical care they need? Please give some examples of people covered by Medicare or Medicaid that are not able to get medical care because of their insurance. I doubt there's even a single person on Medicare or Medicaid who would prefer to have no insurance at all.



You didn't answer my question. If things are as hunky and as dory as you say then you ought to easily be able to name all the new health insurers that started writing coverage after Obamacare came into effect. Excluding the state created companies. If not, why not ?

I didn't say things are hunky and dory. I never said Obamacare has no flaws or can't be improved, but there's no question that the 20 - 30 million Americans who didn't have health insurance and have it now as a result of Obamacare are better off. I don't have time to research which insurers were added to the exchanges and which left, but there are enough insurers for more than 9 million people to get their insurance through those exchanges in 2017.



You also have not even tried to explain the exorbitant premium increases that most Obamacare recipients have seen ; plus the insurers bailing out of exchanges and those who have stopped writing health insurance all together.

Insurers increased rates because they underestimated the percentage of sick people who would enroll. The large increases were probably a one time adjustment. It also doesn't help that one of the political parties want the law to fail. Some of reasons for the increases are Congress not funding risk corridors and a number of states refusing to expand Medicaid.

Rispy_Girl
05-16-2017, 07:18 AM
The problem with there's Medicare/Medicaid bit is that while in theory they can get healthcare they may have to travel far to find a place that takes it and wait in long lines. Additionally you don't get to choose your doctor. If the only doctor (or specialist) that you can get to is a crappy one, then you're screwed. So work the way things are going it will be like the VA, not many places to choose from, potentially have to travel far, you don't get to choose the best, your get what you get. I don't know about you, but iI don't want any of that.

Eric Stoner
05-16-2017, 08:11 AM
No I am not. My views are based on the facts. Yours are not. You don't agree with the law, so you're not willing to acknowledge anything other than Obamacare is a complete failure. You are stating things that aren't true. In a previous post you said:



As I said before, Obamacare was implemented in 2014. Employers did not cut payrolls, they increased them. Approximately 2.95 million jobs were created in 2014. That is the exact opposite of your claim that employers cut payrolls. Not only that, the number of full time jobs increased by approximately 2.8 million. That is the exact opposite of your claim that employers have converted millions of full-time workers to part-time. It seems your statements are based on what you think would happen as a result of the law, not the actual facts. Again, approximately 2.95 million jobs were created in 2014 and the number of full-time workers increased by approximately 2.8 million. These are facts.



I never said anything about unemployment. I only stated the number of jobs created and the increase in number of full-time workers. Again the increase in both was in the millions. Employers did not cut back on employees or full-time workers.



What difference does that make, if everyone on Medicare and Medicaid is able to get the medical care they need? Please give some examples of people covered by Medicare or Medicaid that are not able to get medical care because of their insurance. I doubt there's even a single person on Medicare or Medicaid who would prefer to have no insurance at all.


I didn't say things are hunky and dory. I never said Obamacare has no flaws or can't be improved, but there's no question that the 20 - 30 million Americans who didn't have health insurance and have it now as a result of Obamacare are better off. I don't have time to research which insurers were added to the exchanges and which left, but there are enough insurers for more than 9 million people to get their insurance through those exchanges in 2017.


Insurers increased rates because they underestimated the percentage of sick people who would enroll. The large increases were probably a one time adjustment. It also doesn't help that one of the political parties want the law to fail. Some of reasons for the increases are Congress not funding risk corridors and a number of states refusing to expand Medicaid.

Small businesses most definitely cut back on hiring ; hired part-time rather than full-time workers ; kept their payrolls below the employer mandate trigger point etc.
Historically small businesses provide most of the NEW jobs but have NOT been doing so since Obama-Care.

Whether Medicaid and Medicare patients are getting the care that they need is the question. I didn't write the articles in the Times , the Post and dozens of other outlets but the fact remains that doctors are dropping Medicaid and Medicare patients. The primary reason is that the payments are too low. Those dropped have been forced to look for new doctors or rely on hospitals for their primary care adding to their existing stress.

One of Obamacare's few successes is that it has increased the ranks of the insured. But at what cost and for how long ? Some tin-foil hat wearers claim that Obamacare was designed to fail to grease the skids for a single -payer system. Maybe. So what ? As I have said , a single payer system would not be the worst thing for us to do so long as we are willing to accept the shortcomings : rationed care , waiting lists , a two-tiered system. On the other hand , if Canada ( with 10% of our population) can negotiate with the drug companies and get lower prices why can't we ? I didn't support Bush The Dumber's Medicare Part B for that and other reasons. I thought it was a Relief Act for drug companies and did NOTHING to help control costs. Was I right ?

Funding risk corridors and expanding Medicaid do NOT address the central problems of Obamacare. They simply try to shift the burdens and costs. I can't blame a state for refusing to sign up for a fiscal nightmare and thus refuse to expand Medicaid. For too many states Medicaid is the largest single expenditure in their budgets. New York and California are prime examples but are not alone.

I am NOT defending the current system nor do I advocate doing nothing. A few years ago Taiwan sent a group of government officials abroad to study various health care systems. They were asked whose systems they were looking at and replied : "Everyone except the U.S."
'

RyanXO
05-16-2017, 09:37 AM
Eric Stoner, rick dugan, baer, love your posts. As I have stated at the beginning of this thread, I no longer have insurance because of Obamacare. My employer offered to let me buy health insurance but do you know what his cost was to insure me? 800$. Even if he split it, I would pay 400$ and the deductible was in the thousands. The only plans on the exchange were medicaid style and no one would take them except for a handful of doctors in bad neighborhoods. I am not trying to be a brat, but I don't want to spend 200$ a month on a plan where I have to drive to the hood and miss a whole days work to wait all day at the clinic. I am in Texas, so we have more limited options than other states. I don't have the solid facts to back this claim, but from anecdotal evidence from friends and family who live in PA, CA, and NY they claim Obamacare really works for them. That's fine, but what about me and the other states? Things were a mess before, and I am not saying Obamacare doesn't have pluses. But all I know is I and many people I know no longer buy insurance because it's too expensive. It's essentially catastrophic plans with extremely high premiums. It has gotten so bad that I am becoming an RN just so I can get good benefits.

And I like Baer's idea, where the country has a single payer option but if you have the money you can choose to go private if you want faster/fancier care.

rickdugan
05-16-2017, 10:19 AM
What difference does that make, if everyone on Medicare and Medicaid is able to get the medical care they need? Please give some examples of people covered by Medicare or Medicaid that are not able to get medical care because of their insurance. I doubt there's even a single person on Medicare or Medicaid who would prefer to have no insurance at all.

I didn't say things are hunky and dory. I never said Obamacare has no flaws or can't be improved, but there's no question that the 20 - 30 million Americans who didn't have health insurance and have it now as a result of Obamacare are better off. I don't have time to research which insurers were added to the exchanges and which left, but there are enough insurers for more than 9 million people to get their insurance through those exchanges in 2017.

Insurers increased rates because they underestimated the percentage of sick people who would enroll. The large increases were probably a one time adjustment. It also doesn't help that one of the political parties want the law to fail. Some of reasons for the increases are Congress not funding risk corridors and a number of states refusing to expand Medicaid.

Here we go again with that goofy mythological 20+ million number, which doesn't factor in those who had insurance (employer based or individual) before Obamacare kicked in. Number crunchers who follow the insurance markets actually put the number of new market participants closer to 14 million, 11.8 million of which are new Medicaid recipients. Further, the number of people who might lose insurance altogether is likely far lower than even the 14 million, since some would invariably opt to acquire insurance elsewhere, especially if it is much cheaper absent the bloated mandates, and anywhere from 2 to 7 million of the new Medicaid recipients would have qualified even under the old guidelines. Further, some of those who do lose insurance would do so willingly since they never wanted to buy it in the first place, most especially some of the younger and healthier market participants.

I strongly disagree with the notion that individual market participants are better off than they would have been without Obamacare. I have already discussed what is happening to un-subsidized healthy people in the marketplace and there are millions of us who now have to purchase shitty plans at exorbitant prices because of the massive price distortions caused by Obamacare. But the issue also extends to subsidized participants, who have access to plans with lower deductibles, but even still cannot afford to use the insurance because they cannot afford their deductibles after paying their portion of the premiums as well as their other living expenses.

So in essence the vast majority of the non-Medicaid individual marketplace is paying a large amount of money for what are essentially catastrophic plans that give little back. How exactly are we better off? Many healthy young people never wanted or needed it in the first place and many older market participants were doing far better on an overall cost basis before the mandates kicked in.

Now I will agree that, even with all of its flaws (limited doctor access, waiting lists, etc.) the Medicaid expansion helped some people. I am also going to break ranks with some of the other right leaning libertarians on this board and say that I actually support the Medicaid expansion in principle. I am of the opinion that nobody should have to die early for lack of sufficient medical care, including access to preventative services. The problem is that a number of states simply either cannot afford to pay for their portion of it and/or have population bases that do not want to be forced to fund it, especially as the state cost sharing requirements ladder up over the next several years. For these reasons, I believe that the system as it currently exists is the most optimal solution, as imperfect as it is.

But there is no fixing Obamacare, for all of the reasons previously discussed. You can keep saying that it can be fixed over and over, but it won't change the system's fundamental flaws, including the inherently fatal one relating to the insufficient number of healthy un-subisidized people to support the others (also discussed in my last post). It is both collapsing under its own weight and harming at least as many people as it is helping. Even if Congress did nothing, pretty soon there won't be any insurers left in many parts of the country anyway and all the breezy comments to the contrary won't change that either.

eagle2
05-16-2017, 02:37 PM
Here we go again with that goofy mythological 20+ million number, which doesn't factor in those who had insurance (employer based or individual) before Obamacare kicked in. Number crunchers who follow the insurance markets actually put the number of new market participants closer to 14 million, 11.8 million of which are new Medicaid recipients.

Sorry, but just because you don't like facts doesn't make those facts "goofy mythological". There have been numerous polls and studies that have shown the number of Americans without health insurance has decreased by more than 20 million people since Obamacare went into effect. Here are Gallup's polling numbers on the issue:

http://content.gallup.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/hygaljms_ew8jwzjor7n4w.png

At the end of 2013, approximately 18 percent of Americans did not have health insurance. Obamacare went into effect in 2014. Since then, the percentage of Americans without health insurance has fallen approximately 7 percent. That IS more than 20 million Americans. For some of those people with pre-existing conditions, Obamacare is a matter of life and death. The number would be even higher if one of the political parties wasn't trying to prevent as many people as possible from acquiring health insurance. This is why I try to avoid getting into discussions with you. You're very arrogant and condescending towards anyone who disagrees with you, and you think your views are superior to everyone else's, even though you've been consistently wrong. In previous discussions you insisted that raising taxes would result in businesses hiring fewer people. Taxes were raised in 2013, and the unemployment rate continued to drop and the economy continued to add millions of jobs every year. You insisted that the economy was bad because interest rates were low, yet the economy continued to add jobs and 2015 saw the biggest increase in median income in decades.



But there is no fixing Obamacare, for all of the reasons previously discussed. You can keep saying that it can be fixed over and over, but it won't change the system's fundamental flaws, including the inherently fatal one relating to the insufficient number of healthy un-subisidized people to support the others (also discussed in my last post). It is both collapsing under its own weight and harming at least as many people as it is helping. Even if Congress did nothing, pretty soon there won't be any insurers left in many parts of the country anyway and all the breezy comments to the contrary won't change that either.

You keep ignoring the fact that it could easily be fixed by increasing the penalty for not buying insurance and/or increasing subsidies, to get more healthy people to buy insurance. This isn't some far-out hypothetical theory. Switzerland has the same laws requiring people to buy insurance, except they have much stiffer penalties, and practically everyone buys insurance there. Another factor we have, that other countries don't, is one of our political parties is trying to make the system fail. If both parties tried to get the system to work to benefit as many people as possible, and fix the flaws, there would be even more people benefiting than there are now.

Since you're incapable of having a discussion without making snarky, condescending remarks towards anyone who disagrees with you, this will be my last response to your posts.

rickdugan
05-16-2017, 05:19 PM
Sorry, but just because you don't like facts doesn't make those facts "goofy mythological". There have been numerous polls and studies that have shown the number of Americans without health insurance has decreased by more than 20 million people since Obamacare went into effect. Here are Gallup's polling numbers on the issue:

http://content.gallup.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/hygaljms_ew8jwzjor7n4w.png

At the end of 2013, approximately 18 percent of Americans did not have health insurance. Obamacare went into effect in 2014. Since then, the percentage of Americans without health insurance has fallen approximately 7 percent. That IS more than 20 million Americans. For some of those people with pre-existing conditions, Obamacare is a matter of life and death. The number would be even higher if one of the political parties wasn't trying to prevent as many people as possible from acquiring health insurance. This is why I try to avoid getting into discussions with you. You're very arrogant and condescending towards anyone who disagrees with you, and you think your views are superior to everyone else's, even though you've been consistently wrong. In previous discussions you insisted that raising taxes would result in businesses hiring fewer people. Taxes were raised in 2013, and the unemployment rate continued to drop and the economy continued to add millions of jobs every year. You insisted that the economy was bad because interest rates were low, yet the economy continued to add jobs and 2015 saw the biggest increase in median income in decades.


You keep ignoring the fact that it could easily be fixed by increasing the penalty for not buying insurance and/or increasing subsidies, to get more healthy people to buy insurance. This isn't some far-out hypothetical theory. Switzerland has the same laws requiring people to buy insurance, except they have much stiffer penalties, and practically everyone buys insurance there. Another factor we have, that other countries don't, is one of our political parties is trying to make the system fail. If both parties tried to get the system to work to benefit as many people as possible, and fix the flaws, there would be even more people benefiting than there are now.

Since you're incapable of having a discussion without making snarky, condescending remarks towards anyone who disagrees with you, this will be my last response to your posts.

Seriously eagle, those are just adjusted survey numbers, which sadly are subject to problems like sample bias. There has since been actual full scale data analysis done using actual pre- and post-Obamacare industry enrollment numbers. So obviously Gallup's survey on this was no more accurate than its 2012 political predictions. A link to one of numerous articles on the subject is set forth below.

http://www.investors.com/politics/editorials/did-obamacare-add-20-million-to-the-insurance-rolls-not-even-close/

And I am not ignoring your Switzerland point. Indeed, I spent a great deal of time contending that a comparison between Switzerland and our fractured system is inappropriate and laying out why I believe that your proposed fixes probably won't work here (see post 76 above). You just chose to regurgitate the same beliefs rather than address the counter points made above. I'm not trying to be condescending, but a back and forth discussion requires progression in order to operate effectively.

eagle2
05-16-2017, 06:25 PM
In your post 76, you said:


You keep bringing up Switzerland, but I think you are missing perhaps the most important distinction between Switzerland and Obamacare, which is that everyone in Switzerland must purchase insurance from the same market. They do not have the fractured health care market that we do, with Medicare, employer-provided insurance and Medicaid covering the vast majority of citizens. For this reason, your proposed fix will just not work because there just are not enough healthy and affluent people in the individual marketplace to subsidize the massive number of policies held by sick and/or subsidized participants. All the penalties in the world won't change that, but if you squeeze the relatively small number of us too hard through some combination of harsher penalties and more premium jackups, we will eventually disappear altogether by finding ways to enter the employer-sponsored market.

There are still approximately 30 million Americans who don't have health insurance. Most, or all of these people probably don't have insurance for one of two reasons. They either can't afford it or they don't think it is worth it for them, so they pay the fine instead. Those people who choose to pay the fine are probably healthy people who currently don't need medical care, so they're willing to take the risk of not having health insurance, and instead pay the fine because it is much less than what insurance would cost. Let's say on average it would cost an individual $8,000 to buy insurance and on average the penalty would be $3,000 for not buying it. For that individual, it might be worth $5,000 to him to go without health insurance. If you were to increase the penalty to $6,000 or $7,000, a lot of those people who are willing to pay the $3,000 fine to save $5,000 in insurance cost might decide that rather than paying a fine for $6,000 or $7,000, it would be worth it to pay an additional $1,000 or $2,000 to have health insurance. If a significant number of healthy people were willing to buy insurance rather than pay a fine of $6,000 or $7,000, you would have enough healthy people to better balance out the sick people with high medical cost, which would bring insurance costs down for those who currently have it. Another option would be to do what they're doing in Alaska at the federal level, and have the government reimburse insurance companies for the small percentage of people with exorbitant medical costs, which would bring down insurance costs for everyone else. Another option would be to increase subsidies and allow people with higher incomes to receive subsidies if they have exceptionally high insurance costs. If you're paying more than $20k for health insurance, and this is making it difficult for you and your family to make ends meet, I don't think it's unreasonable to subsidize your insurance so that it's at a reasonable cost. Doing one of the above or some combination of the three would make insurance more affordable for those who have to buy insurance on the individual market. I'm not advocating that we should screw certain people to help others. Anyhow, it doesn't make much difference what I think, because there's not much I can do to change the system. I'm not a Congressman and I'm not the President, nor do I have much influence with either one, so whatever view I have on the issue will not have much of an impact.

rickdugan
05-16-2017, 09:32 PM
In your post 76, you said:

There are still approximately 30 million Americans who don't have health insurance. Most, or all of these people probably don't have insurance for one of two reasons. They either can't afford it or they don't think it is worth it for them, so they pay the fine instead. Those people who choose to pay the fine are probably healthy people who currently don't need medical care, so they're willing to take the risk of not having health insurance, and instead pay the fine because it is much less than what insurance would cost. Let's say on average it would cost an individual $8,000 to buy insurance and on average the penalty would be $3,000 for not buying it. For that individual, it might be worth $5,000 to him to go without health insurance. If you were to increase the penalty to $6,000 or $7,000, a lot of those people who are willing to pay the $3,000 fine to save $5,000 in insurance cost might decide that rather than paying a fine for $6,000 or $7,000, it would be worth it to pay an additional $1,000 or $2,000 to have health insurance. If a significant number of healthy people were willing to buy insurance rather than pay a fine of $6,000 or $7,000, you would have enough healthy people to better balance out the sick people with high medical cost, which would bring insurance costs down for those who currently have it. Another option would be to do what they're doing in Alaska at the federal level, and have the government reimburse insurance companies for the small percentage of people with exorbitant medical costs, which would bring down insurance costs for everyone else. Another option would be to increase subsidies and allow people with higher incomes to receive subsidies if they have exceptionally high insurance costs. If you're paying more than $20k for health insurance, and this is making it difficult for you and your family to make ends meet, I don't think it's unreasonable to subsidize your insurance so that it's at a reasonable cost. Doing one of the above or some combination of the three would make insurance more affordable for those who have to buy insurance on the individual market. I'm not advocating that we should screw certain people to help others. Anyhow, it doesn't make much difference what I think, because there's not much I can do to change the system. I'm not a Congressman and I'm not the President, nor do I have much influence with either one, so whatever view I have on the issue will not have much of an impact.

Well, the CDC and Census put that number at closer to 28.5 million, but of course even that is still a big headline number. Keep in mind though that this number includes undocumented immigrants, children who would qualify for CHIP, people who qualify for medicaid, and folks who are ineligible because they fall in the "medicaid gap." Kaiser puts the actual number of remaining uninsured who would qualify to enter the exchanges at about 14 million. Sounds like a lot, but that is spread over 50 states. Did you see how much Aetna alone is losing on just 4 states this year? $200 million. Other insurers were experiencing similar losses, which is why they pulled out.

And these losses are not limited to exchange participants. There are as many people who buy individual policies direct from the carriers as those on the exchanges. So right now there are already about 19 million people in individual policies in the U.S. And when a carrier pulls out of the state, it means that the carrier stops selling individual policies altogether. Would that additional 14 million, who are largely lower income and eligible for subsidies and/or catastrophic insurance (for the young) really make that big a difference? I couldn't say for sure, but I doubt it. I cannot help but believe that to make it work in some fashion, we would also need to spread the costs over the roughly 150 million people who now receive employer-based coverage and who, as a group, tend to be healthier and more affluent. This, as you know, is the approach that Switzerland took. Instead the U.S. tried to craft a self sustaining insurance market from one of the least affluent and sickest portions of the U.S. population and here we are.

But even if it could work if you added the 14 million who are sitting on the sidelines, I doubt that it would work out as they hoped. Most of them are not buying these policies because they cannot afford them, even with the subsidies. If we put the screws to them and put them between a rock and a hard place, they will start looking for escape hatches. Any who could get themselves out of the stew pot, by switching to employment with employer provided insurance, decreasing hours worked in order to qualify for medicaid or through some other mechanism, would likely do so. Going back to the Switzerland model, their system works because their citizens have no other options, which of course is just not the case here.

Anyway, I hear you on the other stuff. I too am in the camp of believing that medical care should be widely available. I just wish that it had been done some other way.

Eric Stoner
05-17-2017, 10:54 AM
Rick : I like your posts and agree with you most of the time BUT simply wishing for an alternative doesn't cut it afaic. At the risk of sounding professorial I think you have to offer an alternative. Even if it is simply advocating that we go back to how things were before Obamacare.

You and I agree that Obamacare has created an unsustainable system in pursuit of a worthy goal i.e. providing more people with coverage. Eagle is right ; it HAS done that. But that's about it . And as you rightly point out the premiums just keep going up and up and the number of insurers writing health insurance keeps going down. Monopoly or other ways of limiting competition almost always result in higher prices for consumers.

New York is an interesting case in point. After premium increases averaging 16 % LAST year , health insurers are now seeking rate increases for this year of AT LEAST AS MUCH. Sorry Eagle but that doesn't seem to be one-time corrective or adjustment because they miscalculated on how many people would sign up with pre-existing conditions ; or underestimated overall claims or a any other popular alibi or explanation offered by Obamacare defenders. On a different tack there is a bill currently sitting in the N.Y. State Senate that would establish "single payer" in N.Y. How will it be paid for ? By increasing already high taxes on the so-called "rich" which if one looks at the definitions include a good chunk of the middle class. This will accelerate N.Y.'s loss of population. Anyone who can afford to will move to Pennsylvania or even N.J.
Or Texas. Or Florida. Or even New Hampshire or Delaware. It's supporters claim that it will pay for itself by removing the burden of filing claims from doctors and hospitals. Conveniently forgetting all the UNION members who work at both private and public hospitals in billing and collections.

Whether you like Obamacare or not, the giant elephant in the room for it or any other proposal is that we have a growing number of OLDER people who obviously get sick more often and more expensively and a comparatively shrinking pool of younger , healthier people to help pay for their health care. One of the reasons this is blatantly unfair is that as a group , older Americans are a lot wealthier than those entering the workforce and other younger Americans . Yet the younger and healthier are being told to subsidize the older and sicker.

I am sorry Eagle but Rick is right in that your proposed solutions just amount to higher and higher premiums or penalties. No disrespect but what else you got ? Especially something that addresses a real income inequality issue as I have just outlined ?

rickdugan
05-17-2017, 11:50 AM
Rick : I like your posts and agree with you most of the time BUT simply wishing for an alternative doesn't cut it afaic. At the risk of sounding professorial I think you have to offer an alternative. Even if it is simply advocating that we go back to how things were before Obamacare.

I do not believe that we should go back to the way things were. There is a reason why this whole Obamacare fiasco started in the first place, which is that too many people were either (1) going without care altogether; or (2) had to become destitute before they could qualify for life saving assistance from medicaid. In a civilized country, nobody should have to become destitute or even die simply for lack of affordable healthcare.

IMHO the two biggest problems with Obamacare are that (1) it relies on too few to help subsidize too many sick and/or lower income people; and (2) it became bloated with the various coverage mandates. IMHO both of these issues are a result of political avoidance and pandering that derailed the legislation from achieving its original goals, which were to ensure access to essential preventative health services and to provide care when one got really sick.

I think that the Republicans are taking the right first steps in rolling back the mandates while restricting the rights of insurance companies to deny access based upon pre-existing conditions so long as one keeps up continuous coverage. The ability to customize policies should, all by itself, help bring down the costs of coverage for many people who just do not need all of those services (like my family).

But what I am skeptical about is whether the larger insurers will ever return to the individual marketplace without some serious incentive to do so. After all, why would they voluntarily return to offering insurance to an individual marketplace that is much smaller, sicker and less affluent than the much larger group plan market, especially when they cannot weed out individual applicants based upon pre-existing conditions? The likely answer is that they won't, at least without some motivation.

What I would like to see is a requirement that insurers who sell group plans in a given state must also offer the same plans with the same benefits in the same price ranges to the individual marketplace. This is what should have happened in the first place. This will effectively force insurers to participate in the individual marketplace in a meaningful way while spreading the costs over a much larger pool of participants. This would also eliminate the two tier health insurance system that has developed since this horrible legislation went into effect, with group policies providing much better access to doctors than those issued in the individual market.

The one place where I disagree with the current legislation, as far as it goes, is in rolling back medicaid. 138% of the official poverty level is still a really low threshold and anyone who makes that little likely really needs the health coverage.

Anyway, I'm just one dude shooting off on a stripper support site, so my opinions matter about as much as a fart in the wind. But I somehow suspect that whatever comes out of the Senate will at least include a continuation of the medicaid expansion and some relief from the mandates.

eagle2
05-17-2017, 03:32 PM
Anyway, I hear you on the other stuff. I too am in the camp of believing that medical care should be widely available. I just wish that it had been done some other way.

I wish it had been done differently too. IMO, Obamacare is overly complex and it doesn't cover everyone. I would rather have had a more simpler approach. Maybe just increase taxes and put everyone who doesn't have health insurance on some type of group plan, and provide tax credits for individuals who choose to buy insurance on their own and employers who provide health insurance to their employees.

I support Obamacare, because right now there is no viable alternative. The GOP plan makes drastic cuts to Medicaid and also will make insurance way more expensive for older Americans. If Obamacare gets repealed, I think it's very unlikely that Congress will come up with anything that would cover all of the people who would lose their insurance, so for now I would rather see Congress fix the flaws in Obamacare than get rid of it.

eagle2
05-17-2017, 03:41 PM
I am sorry Eagle but Rick is right in that your proposed solutions just amount to higher and higher premiums or penalties. No disrespect but what else you got ? Especially something that addresses a real income inequality issue as I have just outlined ?

How would having more healthy people paying into the system increase premiums? As I mentioned in an earlier post, when rates were set to increase by 45 percent in Alaska, the insurance commission made reforms where government would pay for the small number of people with very high medical costs, and the premiums ended up increasing by 7 percent instead of 45 percent.

As I mentioned in my above post, I would have rather Congress come up with something simpler than what they ended up with, but Obamacare is what we have and I don't see any alternative plans being proposed that would work better. I'm against doing anything that would end up with millions of people losing their health insurance.

rickdugan
05-18-2017, 03:22 AM
I wish it had been done differently too. IMO, Obamacare is overly complex and it doesn't cover everyone. I would rather have had a more simpler approach. Maybe just increase taxes and put everyone who doesn't have health insurance on some type of group plan, and provide tax credits for individuals who choose to buy insurance on their own and employers who provide health insurance to their employees.

I support Obamacare, because right now there is no viable alternative. The GOP plan makes drastic cuts to Medicaid and also will make insurance way more expensive for older Americans. If Obamacare gets repealed, I think it's very unlikely that Congress will come up with anything that would cover all of the people who would lose their insurance, so for now I would rather see Congress fix the flaws in Obamacare rather than get rid of it.

That's where we diverge. I'm not sure why certain parties assume that anyone who has health insurance is automatically better off, but Obamacare is so bad that this notion has been proven false. Outside of perhaps Medicaid recipients, many Obamacare participants are paying for insurance that they cannot use anyway, which has had the effect of draining their critical resources and making them substantially worse off. They would have been far better off it they could keep that cash and just pay doctors out of pocket. Indeed, that is happening more and more now anyway, with urgent care clinics popping up all over the place and charging as little as $100-120 per visit.

So if I had to choose between keeping Obamacare or a full repeal with no replacement, I would definitely choose the latter. But I do not think it is going to come to that and I am generally happier with the more targeted approach that is being worked on now.

rickdugan
05-18-2017, 05:01 AM
The GOP plan makes drastic cuts to Medicaid and also will make insurance way more expensive for older Americans.

Oh, and to specifically address this piece...

And?

Insurance should be more expensive for older Americans because they incur far more medical expenses. And by older, you of course mean 50-64 year olds since anyone older gets Medicare. One of the numerous perverse effects of Obamacare was to force younger people, including those with families, to effectively subsidize the early retirements of others by shouldering a significant portion of these early retirees' health care costs. This needs to stop. I am paying almost $20,000 in premiums alone each year for a shitty plan for a family of 5 so that others just a few years older than me can lay around on the beach all day.

This was one of the numerous political pandering components of Obamacare that has made it the monstrosity that it is. A fair percentage of these older people either have the assets to shoulder their own burdens and/or could still work if they needed to. For those who truly cannot afford it and cannot work, there already exists social safety nets, including tax credits (even under the new plan), disability and medicaid. I would not object to tax credit and medicaid expansions for the gap people who truly cannot work or who are working but still cannot shoulder the higher premium costs. But forcing working families to shoulder the burdens of people who voluntarily choose to reduce their incomes in favor of more enjoyable lifestyles is unconscionable.

RyanXO
05-18-2017, 10:30 AM
Oh, and to specifically address this piece...

And?

Insurance should be more expensive for older Americans because they incur far more medical expenses. And by older, you of course mean 50-64 year olds since anyone older gets Medicare. One of the numerous perverse effects of Obamacare was to force younger people, including those with families, to effectively subsidize the early retirements of others by shouldering a significant portion of these early retirees' health care costs. This needs to stop. I am paying almost $20,000 in premiums alone each year for a shitty plan for a family of 5 so that others just a few years older than me can lay around on the beach all day.

This was one of the numerous political pandering components of Obamacare that has made it the monstrosity that it is. A fair percentage of these older people either have the assets to shoulder their own burdens and/or could still work if they needed to. For those who truly cannot afford it and cannot work, there already exists social safety nets, including tax credits (even under the new plan), disability and medicaid. I would not object to tax credit and medicaid expansions for the gap people who truly cannot work or who are working but still cannot shoulder the higher premium costs. But forcing working families to shoulder the burdens of people who voluntarily choose to reduce their incomes in favor of more enjoyable lifestyles is unconscionable.

Exactly. Not to mention rent and college costs are at all time highs for young people. I don't even see myself being able to start a family or get a home until my mid thirties because rent and school eats up everything and I will have debt when I finish at the university. I don't see how it's fair I should have to subsidize older adults who had it better financially when they were my age. (not everyone but you get my point)

eagle2
05-18-2017, 01:29 PM
Insurance IS more expensive for older Americans (under 65). Under Obamacare insurers can charge older Americans 3x as much as younger Americans for their premiums. With the GOP House bill, insurers can charge older Americans 5x as much. That means an individual plan that costs younger Americans $8,000 would cost older Americans $24,000 with Obamacare. Under the GOP House bill, that same plan would cost older Americans $40,000. Under Obamacare, most Americans 26 and under don't pay anything for insurance if they're able to stay on their parents plan.

rickdugan
05-18-2017, 02:19 PM
Insurance IS more expensive for older Americans (under 65). Under Obamacare insurers can charge older Americans 3x as much as younger Americans for their premiums. With the GOP House bill, insurers can charge older Americans 5x as much. That means an individual plan that costs younger Americans $8,000 would cost older Americans $24,000 with Obamacare. Under the GOP House bill, that same plan would cost older Americans $40,000. Under Obamacare, most Americans 26 and under don't pay anything for insurance if they're able to stay on their parents plan.

The problem is that older people need, on average, much more than 3x the care that the younger people do. Shifting the premium multiple from 3x to 5x just allows insurance companies to more accurately allocate the true costs of care. That way I no longer have to pay higher premiums for five people just to pay for the care of early retirees and other "older" people.

Oh, and the insurance for a 25 year old is not "free" just because she is on a parent's plan. If it is an individual marketplace plan, then the parent also has to pay a bloated premium on the child's coverage in order to finance the artificially low premiums charged to the aforementioned early retirees. But not all 25 year olds have parents who are able or willing to extend coverage anyway, so let's not assume facts not in evidence. ;)

Oh yeah, and those numbers are goofy for the following reasons: (1) Many young individuals can get coverage at far lower than 8k per year; and (2) tax credits would also apply unless the older person is wealthy, in which case he/she can afford to pay for his/her medical coverage anyway.