Response to TrumpCare not so great

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anonymous_coward
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Well Tom C has a small point.

Well Tom C has a small point. Insurance companies existed before the mandate, so it's not inconceivable that they could exist after the mandate as well (though they do make money administering self-funded plans, which is something like 25% of all insurance plans, so that revenue stream is immune to whether the mandate exists or not).

But not if you keep the guaranteed issue (no price discrimination based on pre-existing conditions) regulation in place.

However, this is a fantastic experiment, and if it goes wrong, the blame falls squarely on Trump & the GOP.

So hey, it's win-win! Or is it "Winning-Winning"?

Ugenetoo
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AC

AC
Government less efficient?
What is any more inefficient than when our HC system, not only has to support the government overseers, but another huge bureaucracy to pay the bills, as well as another huge number of people to determine what to send for bills, all this before anyone even gets to see the actual provider.
I just listened to Ryan's plan.
Health savings account? Get rid of insurance and FORCE people to shop for their healthcare options.
Tax credits: Subsidies? Get rid of the insurance companies and most of the HC options will drop to a level that would be affordable.

My plan?
Each and every person is responsible for $8,000 worth of their own HC spending.
If you would like to buy insurance for that $8K, have at it.
Beyond that, government pays.
That way, everyone has skin in the game.
You smoke, you can pay up to $8000 for the privilege of the increased HC costs.
You want to sit on the couch and gain weight to the point that it becomes a health risk, feel free to pay that $8K.
We have no choice but to let this government deal with the problem by instituting single payer above that yearly $8K cap
They screwed it up with their meddling, and it is too much of a drag on our economy to let it continue.
Ryan's plan will fold up just as Obama's is in the process of doing.

anonymous_coward
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So what you're basically

So what you're basically proposing is a single payer system with an 8k deductible.

The problem with this is that, for high-cost patients (think cancer patients, or old people with multiple problems), there's again nothing to tell the medical providers that procedure X or drug Y is too expensive. So a drug maker has nothing to lose by developing a $1,000,000/dose drug that extends your life for 15 days.

Then, the government has to start saying, "no, we don't cover your overpriced drug", which is essentially a death panel, and would be subject to graft, ineptitude, etc.

Or, the government just goes bankrupt trying to pay for spiraling procedures that have little return.

At some point, people (liberals in particular) have to start admitting that wealthy people should get better health care than poor people. However distasteful that may be, it will ultimately drive prices down and effectiveness up, and in the long term, make health care more affordable for poor people.

Matt
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AC,

AC,

Can you explain the conclusions in your final paragraph? How will costs go down and effectiveness go up, in those circumstances?

johnw
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Cutting the insurance

Cutting the insurance companies out of the health care market (lost revenues) would create a huge negative ripple in the stock market, not a good thing for a lot of investors.
A single payer system that excludes people below a certain income level (like obamacare ) leaves the system underfunded. If everyone is paying something into the system the contributions should out run the costs, not everyone is sick all of the time..
And obviously there has to be some provisions for the disabled , unemployed etc......
Creating a huge giverment agency to run a single payer system just escalates costs.(obamacare) and the inefficiency.(obamacare)
If we are what if-ing it
What if the government went to the insurance companies with a menu of health options(that make sense) that they want people to have and just plain and simply ask "how much will it cost to provide this equal coverage for everyone.? here's what we want to offer the American people for health care coverage......
One single plan at a single cost.No bronze, tin gold or plastic........a single equal plan..
Seeing that the insurance companies will have ALL of the people under this plan the government ought to be able to negotiate some lower costs.
Let the insurance companies manage the program and cut the government out of the picture because it's being managed for profit the insurance companies will find a way to make money.
And yes the taxpayers will have to subsidize this to some extent , but we do now .....but with more people paying into a plan that gives excellent coverage with reasonable , affordable deductibles we might be able to start incentivize people to live healthier, get preventive care, and reduce the use of emergency rooms as their primary physician....
And allow people who can afford them to have HSA accounts ........OR possibly straight up allow people to straight up deduct their pre deductible medical expense or a percent of them of their tax liabilyt ..if they have no tax liability they get no credit....

But as long as we have people who are excluded from having any skin in the game what so ever the burden of the cost will never go down...(obamacare)

Go ahead beat on it..... I can take it ..Lol

Tom C
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Huh!

Huh!

Our governmentalists think that health insurance will only be sold if people are REQUIRED to buy it.

There is no other way that people will buy insurance, I suppose.

Gee... I guess no one ever bought it before it was required.

lol.

Mike G
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Everyone wants something for

Everyone wants something for nothing.

Old bastards and sick bastards should have to pay for their health insurance.

Young healthy people should not have to buy health insurance and if they get sick it comes out of their pocket.

The whole idea of Obamacare was to pump money into the racketeering of the health care industry until at some point the insurance companies went belly up, thus forcing universal coverage. Which is where we are going, of course, the 800 lb gorilla in the room is the national debt.

It is tough to have your cake and eat it too which Congress and the POTUS has had for some time, but when will it end?

If you want to bomb the crap out of Yemen everyday it might be tough to fund universal and of course with a 20 trillion dollar debt it may just be pointless to even worry about it.

Bomb away, pass universal, crank the credit to beyond payment what is the difference at some point. I'm predicting a 60k Dow and a 25 dollar Taco.

Ugenetoo
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If putting the insurance

If putting the insurance companies out of business would make the stock market tank, then there is something wrong with the stock market.
Insurance companies or affordable HC.
We will never have both.
The choice should be quite apparent.

johnw
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If you are working or paying

If you are working or paying taxes you are going to pay for health insurance for those who aren't one way or another,,,,, simple fact. That 20 something kid who is healthy and has no insurance and gets in a car accident ,needs serious medical attention, you'll pay for it in the end.
The broader idea might be to convince everyone , of the value of a system we all contribute to, not force, but convince. I know we all love the idea of the"free market' but the free market greed of for profit health care is what created this mess , not people needing medical care.,,,
,If anyone thinks that insurance companies that now have these high premiums and deductibles are going to voluntarily lower rates because they can "compete" across state lines , well I've got a bridge ...
.If you were working at minimum wage and you could have health care coverage for $25 bucks or you could cover you and your family for $75 a week wouldn't you buy in? I think selling a great health care system might be like sex , it's all in the approach , as opposed to obama's and the left's idea of foreplay of yelling BRACE YOURSELF.....
I wish I had a great answer ,but the one thing I know is that our brilliant leaders can't get past themselves enough to truly work on a plan that takes care of the American people in a realistic way........enough this morning I've got to go to work

Roger Ek
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Here's a thought: Obamacare

Here's a thought: Obamacare is run by the IRS. Why not just abolish the IRS too?

Ugenetoo
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You are right Johnw.

You are right Johnw.
What sticks in my craw is the fact that, through insurance companies, I pay for others poor decisions which I have absolutely no control over. Smokers, drug abusers, thrill seekers, baby machines, as well as bloated insurance CEO salaries and the myriad underlings pushing paper that requires another complete workforce in the HC industry to read and respond to that paperwork.
We've all heard about the $40 aspirin, or the $2 Q-tip.
In a free market, just how many $40 aspirin would be sold?
My other half's parents both died young with cancer, so her doc put her on Tamoxofin, which, at the time was thought to help guard against breast cancer.
$180/ month here at the local pharmacy. $160/ month at Walmart.
We went across the Canadian border and bought a three month supply for $32.
WHY?
THE US INSURANCE INDUSTRY.

anonymous_coward
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"Can you explain the

"Can you explain the conclusions in your final paragraph? How will costs go down and effectiveness go up, in those circumstances?"

Right now, health care providers (hospitals, drug makers) have little incentive to make anything cheaper. The deciding factors for choosing health care for most patients are 1) do I like the doctor/hospital; 2) is it convenient for me; 3) will it extend my life; 4) what are the side effects.

So as a result, providers cater to what patients want. If a new drug reduces the risk of heart attacks by 10% but it costs a fortune, nobody cares because everyone else will pay for it via their premiums.

Contrast this with lasik eye surgery. which is an elective surgery and thus not covered by most insurance plans. The cost of performing a lasik has gone down by about 40% over the last 20 years. Why? Because when choosing whether or not to get lasik, price is a deciding factor.

Now, once you start to apply downward pricing pressure on medical providers, premiums start to go down, deductibles start to go down, and more poor people can afford to get insurance (this is what I meant by effectiveness).

anonymous_coward
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@johnw: "What if the

@johnw: "What if the government went to the insurance companies with a menu of health options(that make sense) that they want people to have and just plain and simply ask "how much will it cost to provide this equal coverage for everyone.? here's what we want to offer the American people for health care coverage......"

Well that's what the exchanges were supposed to do. Government says, you have to cover X, Y, Z, and the private insurance companies put their plan & cost on the exchange, and it's (supposed to be) easy to shop for a plan.

Now, there are multiple tiers of coverage, so that there are different price levels, but it's the same basic idea.

"But as long as we have people who are excluded from having any skin in the game what so ever the burden of the cost will never go down...(obamacare)"

This was true before ObamaCare too (I assume you're talking about Medicaid recipients?)

anonymous_coward
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@Tom C: "Our governmentalists

@Tom C: "Our governmentalists think that health insurance will only be sold if people are REQUIRED to buy it.

There is no other way that people will buy insurance, I suppose.

Gee... I guess no one ever bought it before it was required."

No, the problem is not that people won't buy it - the problem is that if you force insurance companies to charge people with preexisting conditions the same as everyone else, then people will not have insurance until something really bad happens, and then they'll sign up.

TrumpCare tries to resolve this by allowing insurers to charge 30% more in premiums for 1 year if someone has gone 2 months without coverage.

To me, that 30% a) won't make up for all the lost premiums of people who end their insurance; b) will discourage people from getting back on insurance after they go off it (let's say because they lost their job).

anonymous_coward
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@johnw: ",If anyone thinks

@johnw: ",If anyone thinks that insurance companies that now have these high premiums and deductibles are going to voluntarily lower rates because they can "compete" across state lines , well I've got a bridge ..."

The cross state lines thing will reduce premiums for highly regulated states in the short term (because it reduces the number of things that are required to be covered).

But it doesn't solve the underlying cause of rising health care costs.

I actually had an idea (in the shower, where all my great ideas come from) about how to keep costs down. It would be a non-starter for Democrats for several reasons, but let's say that instead of having an overall deductible where you pay 100% up to a certain point and then 0% after that, you mandate that insurers have a sliding deductible.

So, you pay 100% up to $3,000, 10% from $3,000 - $20,000, 5% from $20,000 -$100,000, and 1% beyond that. Obviously the exact numbers could be tweaked, but the point is that the patient is always on the hook for some fraction of the cost (has some skin in the game, as johnw would say).

Now, when a patient is offered a drug that will extend their life for a month, cost really matters.

(Obviously this requires full price transparency - meaning that a patient must be presented with the cost before they decide whether go ahead with a procedure. This doesn't even happen now - sometimes it takes several months before you can even find out if something is covered by insurance.)

Roger Ek
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The goal was to abolish

The goal was to abolish Obamacare. Focus on the goal. Ryancare is worse than Obamacare. It cannot work. The man has no concept of economics or cash flow in the marketplace. He is working toward his goal of a bloated Romneycare as they have in Massachusetts.

The American Action Network (AAN) announced yesterday that it will spend $500,000 on TV ads in the districts of 30 members of the House Freedom Caucus. This is a Paul Ryan affiliated PAC and they are attacking the Republican wing of the Republican Party. Their hatred of conservatives is palpable. They exist at the national party level, the state party level (in all states) and the county level. In larger towns they exist at the city level. Just look at Bangor. They exist in the Trump White House. Just take a look at Reince Priebus. Donald Trump is no dummy. Keep your friends close and your enemies closer. That is why Reince is in the White House and the day that Steve Bannon kicks him out on his butt will be a happy day indeed.

FLNext
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A_C in #46 above describes

A_C in #46 above describes actual insurance vs.prepaid care. Yes, we can quibble about the percentages but thanks for putting it out there.

johnw
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You me and average joe have

You me and average joe have almost zero leverage with the people (congress) who are writing health care legislation. Insurance , big pharma, for profit hospitals have huge lobbies and millions in pay off money ....who do you think is going to get the best deal....??
I have zero faith in the"free market" when it comes to health care.......there's just to much money to be made by screwing people......
When they talk about competition in the health care industry may daughter who is a doctor told me about a large for profit hospital system in the Cincinnati area that was buying up all the small independent health clinics in the area..... a reduction in patient choices... Do i like the idea of a government run health care system .... not really but to me at this point in time it might be the lesser of two evils...

johnw
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You me and average joe have

You me and average joe have almost zero leverage with the people (congress) who are writing health care legislation. Insurance , big pharma, for profit hospitals have huge lobbies and millions in pay off money ....who do you think is going to get the best deal....??
I have zero faith in the"free market" when it comes to health care.......there's just to much money to be made by screwing people......
When they talk about competition in the health care industry may daughter who is a doctor told me about a large for profit hospital system in the Cincinnati area that was buying up all the small independent health clinics in the area..... a reduction in patient choices... Do i like the idea of a government run health care system .... not really but to me at this point in time it might be the lesser of two evils...

FLNext
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I'm hoping that the end

I'm hoping that the end result of the current rino proposal will be amended or die. If there is support for Ryancare I expect a purge of those who vote for it. The problem is that Dems may profit. Johnw, are you famliiar with Maine Health? No need to look to Cincinatti.

Ugenetoo
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at this point in time it

at this point in time it might be the lesser of two evils...

Sad to say, I view it as the only option at this point.

Tom C
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So, you pay 100% up to $3,000

So, you pay 100% up to $3,000, 10% from $3,000 - $20,000, 5% from $20,000 -$100,000, and 1% beyond that. Obviously the exact numbers could be tweaked, but the point is that the patient is always on the hook for some fraction of the cost (has some skin in the game, as johnw would say).

I like this idea, but the pols will trot granny out every time - When granny had to pay $35 for a doctor's visit, they told us that because of the greedy insurance companies (and Republicans, no doubt,) she now has to eat cat food.

When granny has to pay $5000 for a $100,000 medical procedure, the lefties will REALLY be screaming bloody murder (although many seniors on fixed incomes nowadays routinely shell out $10,000-$15,000 a year for medical expenses - including Medicare B, D, medigap, and various out-of pocket. However, the powers that be, and their paid-off politicians are getting their pockets filled, so there is no complaint.)

It's going to take some guts to fix this corrupt system. It's been tweaked every which way over the last 30 or 40 year, it doesn't represent a market system at all, other than for a few self-pays. There are going to be a lot of pigs squealing very loudly when you try to take anything out of this trough.

Matt
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Just have a single payer

Just have a single payer system with a 1 or 2% income tax and be done with it. If rich folks (or anyone) wants to pay out of pocket beyond that, for other plans or procedures, they can, just like sending their kids to Exeter. And businesses will no longer be saddled with the responsibility of providing health insurance. (How'd that start, anyway?) Drug prices will come down, procedure prices could be more standardized, etc. you could even still have deductibles so that folks don't run out and get everything on the menu, whenever they've got an ache or pain.

Have the govt set up the system and the health care industry will figure out how to make it work for them, rather than the other way around.

Fire away.

Tom C
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Just have a single payer

Just have a single payer system with a 1 or 2% income tax and be done with it.

That reminds me of Gerald. Gerald pays 1.45% of his wages to the Medicare tax, and proudly boasts that he is "helping pay [my] medical expenses."

lol.

Fire away.

Ummm... because medical costs are about 17-20% of the GDP?

johnw
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Let's face it the real

Let's face it the real objection to a single payer system is that the insurance companies might not get as much as they think they deserve.... and if that happened politicians wouldn't receive the payoffs and bribes they deserve.... wow as this thing snowballs who knows what could happen cats living with dogs????
There's an old saying , the surest road to failure is trying to please everyone. The current gridlock and morass is pleasing no one.
I want someone to explain to me how a system that makes insurance too expensive for millions to afford even rudimentary care is going to alleviate the cost of their care when they do get sick, those costs will just be passed on to the rate payers and the taxpayers....isn't it smarter to have everyone who can paying into a system that spreads the cost over a broader base?These [people will not be denied care , and the costs will be passed on.....
Right now I'm paying about 7% per week of my salary in premiums......for "free market" coverage with a $6450 deductible.............trust me I could live with 2 , 3 or 4% and put the difference into a HSA or a retirement fund.... Not having an equal plan to provide health care for the low income earners is stumbling over dollar bills to pick up pennies in the long run.....

Matt
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Yah, you're right. I was way

Yah, you're right. I was way off, looking at a number representing potential savings and not total cost per person.

Ugenetoo
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Johnw

Johnw
This forum probably isn't the best one to discuss the HC crisis.
Most here are over 64 and already got theirs.
This mirrors rest of the conservative populace in that a large percentage are retirees on Medicare.
They feel for their children and grand children's predicament, but not quite enough to get behind a solution.

BTW, beyond that 7% of your own income you are paying, how much is your employer paying.

johnw
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Ugentoo, the same I'm over

Ugentoo, the same I'm over 60 myself but have kids and grand kids and lots of extended family..... It can't always be about yourself....

Roger Ek
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Matt wondrs"

Matt wonders"
"And businesses will no longer be saddled with the responsibility of providing health insurance. (How'd that start, anyway?)"

Unions

anonymous_coward
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@Tom C: "When granny has to

@Tom C: "When granny has to pay $5000 for a $100,000 medical procedure, the lefties will REALLY be screaming bloody murder ....
It's going to take some guts to fix this corrupt system. It's been tweaked every which way over the last 30 or 40 year, it doesn't represent a market system at all, other than for a few self-pays. There are going to be a lot of pigs squealing very loudly when you try to take anything out of this trough."

Yes. That's why my idea would be a non-starter among Dems.

Agreed on the corruption, but I would also add that it's not corrupt towards insurance companies, it's corrupt towards sick people.

If you think about it, sick people are getting top shelf health care, for free, paid for by healthy people.

I personally feel like a doable first step is to mandate price & coverage transparency within 24 hours of a diagnosis. I work in credit card fraud, and we have to decide whether a transaction is fraudulent or not in less than a second. It has to be possible for insurers to decide whether a procedure is covered in a timely manner. (Though I'm a bit at a loss as to how to enforce it.)

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