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re: Who wants to point out the flaws of this healthcare bill?
Posted on 9/21/17 at 7:46 pm to bonhoeffer45
Posted on 9/21/17 at 7:46 pm to bonhoeffer45
quote:
In fact, the free-rider problem is the elephant no Republicans want to ever acknowledge is int he room of their ideas on kicking people off medicaid and raising rates on older Americans.
Mostly because the only acceptable answer they ever came up with, the individual mandate, they now decry because they've convinced their voters it's the boogey man.
Not for any rational, sane reasons.
1
Posted on 9/21/17 at 7:51 pm to BamaAtl
quote:
Mostly because the only acceptable answer they ever came up with, the individual mandate, they now decry because they've convinced their voters it's the boogey man.
Not for any rational, sane reasons.
At one time, before Cassidy downed the GOP snake oil red pills on trying to sell cutting peoples insurance as covering more people, he actually proposed an interesting germ of an idea with his automatic enrollment proposal.
Of course, that had to be thrown away, along with most of Cassidy-Collins, so that we could get Cassidy-Graham which pretends the vicious cycle of uncompensated care and a less healthy population just doesnt exist, and states will magically fix it by giving insurers the freedom to make their product unaffordable for the customer base they don't want. Which is actually 100% counter intuitive.
And the individual mandate, much like cap and trade, once Democrats go "huh, maybe that is a good idea!" Republicans immediately run away from it for political posturing. Signal to their front line of talk radio and Fox to disseminate that position into their audience.
This post was edited on 9/21/17 at 7:56 pm
Posted on 9/21/17 at 7:59 pm to NC_Tigah
quote:This has always been why I find states (down to local) power so beneficial.
As should have always been the case. You'll have 50 different laboratories working toward solutions, as opposed to one.
That being said, I don't think the value of this is because state and local governments are more competent. It's because this happens organically, based on the needs, focus, and support of the government and citizens. In addition, it is independent of the Federal government. It's purely a bottom-up approach.
On the other hand, in my experience, when states are required to implement and comply with federal policy, the incompetency of the state government and bureaucracy is on full display. In fact, I bet they have more incompetent individuals at state levels with resources and talent dispersed. Plus it compounds federal overreach with state overreach.
So most if not all the value of those "experiments" is probably lost when it is forced and restrictive with equally or even more incompetent individuals running the experiments.
So taking one large pile of crap with one incompetent entity trying to make it less crappy, doesn't somehow become better when dividing it into 50 piles of crap and requiring 50 new, inexperienced, and equally or more incompetent entities to get to make it less crappy.
This post was edited on 9/21/17 at 8:02 pm
Posted on 9/21/17 at 8:02 pm to bonhoeffer45
quote:Not necessarily, but I do eat the costs. As with any charity, the reward is internal.
And if they can't pay, the hospital eats the costs
Posted on 9/21/17 at 8:34 pm to NC_Tigah
quote:
Not necessarily, but I do eat the costs. As with any charity, the reward is internal.
Do you work at a major medical facility like Ochsner? Or a private practice?
If the former, that really isn't going to be your final decision to make, the latter, that is kind and thoughtful, but I would assume that generosity only goes so far? You can't fill up your day with just patients that can't pay, you would close down. You have to pay for the equipment, nurses, supplies, utilities, accounting services, malpractice insurance, collections department, employees, your salary, etc. There are real opportunity costs to patients that can't pay the bill, even a portion of it. And while maybe some people like yourself can find ways to incorporate helping them into your practice without shifting costs, the evidence of that succeeding on the macro scale is not there. In fact the opposite.
This post was edited on 9/21/17 at 8:38 pm
Posted on 9/21/17 at 8:46 pm to Adam Banks
There needs to be a guarantee that big liberal states that squander their money don't get bailed out later on.
This post was edited on 9/21/17 at 8:52 pm
Posted on 9/21/17 at 8:55 pm to LSU Patrick
quote:That's fair, but then it would be fair that if they are one of those states who gives more to the federal government than it recieves, that it gets to use that difference to cover the costs.
There needs to be a guarantee that big liberal states that squander their money don't get bailed out later on.
Posted on 9/21/17 at 8:55 pm to bonhoeffer45
quote:
Nothing is stopping that now.
You are wrong here. A state cannot create their "own" individual market. They are stopped by the ACA. If Georgia wanted to create an individual market that sold plans that didn't include "essential health benefits" or "community rating" they cannot do it. It cannot be done.
quote:
Which leaves risk pools less healthy. Exacerbates an already bad free-rider problem. Increases the occurrence of uncompensated care that paying customers will eat in the form of higher taxes, higher costs, higher premiums, and loss of productivity(healthy people are more productive then unhealthy people).
Do you even realize what is happening now? Do you realize why premium costs are spiraling out of control in the individual market? FREE RIDERS AREN'T BUYING POLICIES NOW! You can't charge a 30 year old $350 a month premium and expect him/her to pay. This is why Obamacare is blowing up. You mandated the hell out of it making it so expensive that young people can't afford it. They would rather pay the penalty. Obamacare has created risk pools with too many sick/elderly. That is why some states are seeing 30% yoy premium increases. There is one county in Virginia with an 81% increase this year. Do some fricking research on why your beloved Obamacare is failing.
quote:
History pre-2009 says otherwise.
Wrong. This is not pre 2009. Graham/Cassidy block grants money to provide for those with preexisting conditions. If they don't provide for those with preexisting conditions THEY GET NO MONEY. There are strings attached. THE STATES WILL WANT TO USE THIS MONEY. This is left wing fear mongering...plain and simple.
This post was edited on 9/21/17 at 8:58 pm
Posted on 9/21/17 at 9:08 pm to WaWaWeeWa
quote:
What bothers me is that Republicans are slightly changing Obamacare, and in the process are going to assume responsibility of the new plan.
Which is exactly, as you mentioned, what they probably planned all along. They WANT the GOPe to do something drastic about this. Go ahead, do what the OP and many others on here wants. If it falls through, or if the # of beneficiaries is less than the number of people who lose insurance, it falls completely under the GOPe and the media will ensure that it how it is viewed.
This entire insurance scheme has been a time-bomb. The premiums are not going to go down to pre-ACA. The insurance companies (forget the DEMs) will make it so.
Posted on 9/21/17 at 9:17 pm to frogtown
quote:
You are wrong here. A state cannot create their "own" individual market. They are stopped by the ACA. If Georgia wanted to create an individual market that sold plans that didn't include "essential health benefits" or "community rating" they cannot do it. It cannot be done.
Like has been said, the ACA sets a baseline for what has to be covered, so does Cassidy's' bill. They just lower the threshold while eliminating federal components on their end. But use waiver processes to control how states use the block granted money. Amongst things they will allow is for states to let insurers discriminate in pricing based on pre-existing conditions and to allow the age rating to increase from 3 to 5x. Meaning the oldest bracket in the insurer pool can be charged five times the rate as the youngest. All together making insurance unaffordable for many people. The federal money allocated is less over time(and in some states like Louisiana immediately less as we have to send a portion of our money we would get under the ACA to states that said they didn't want that money) so it means less money to subsidize people, less for potential high risk pools, reinsurance, or risk corridors. The elimination of the mandate allows more healthy people to skirt the system until they need it. Though may find themselves priced out like pre-2009 if they need to come back. Speaking of, Cassidy has also signaled they would allow waivers for states to bring back payout caps. So that policy you buy might not cover enough if you get into a really serious bind like cancer or a bad wreck.
I do know why premium costs are rising, the actuary institute of America, that represents the body of people that calculate out and forecast upcoming risk exposure to determine annual policy holder premiums, releases briefings every year:
LINK
Sick people don't just get better when the ACA is gone, they are still sick and they will still need and get treatment, they just won't be in an arrangement where the provider will be compensated accordingly. Hence, the free-rider problem.
You won't see me saying the ACA is perfect, or that there isn't a problem of people in the middle that don't qualify for subsidies, that can't afford premiums or their deductibles. I was in that number for a period of time. The problem I am having, is finding where Cassidy's bill improves this situation overall? Like I said, if you live in Louisiana, in all likelihood your problem is not going to change much, if at all. If you are in a red state that will seek waivers like I mentioned, you might get some skimpier coverage with higher deductibles and a lower premium, but there is no magic in there that is bringing down root healthcare costs or giving you more money to afford this expensive product, at the level of benefits and access you seem to want, at current market rates. Or even rates under the waiver scenario.
Maybe calm down a bit, take it off caps lock, and start putting as much skepticism in Cassidy as you do toward Obama, and you will begin to see why this bill is so farcical.
This post was edited on 9/21/17 at 9:23 pm
Posted on 9/21/17 at 9:20 pm to bonhoeffer45
quote:
The only thing this bill does on that front is allow those experiments to go below the threshold they are currently held to, and eliminate things like the federal exchange marketplace which states could of always set up on their own. We can debate the merits of doing that, but that is all that is changing on the state experimentation front.
Here is the deal. Graham/Cassidy allows left wingers the opportunity to prove YOUR WAY IS THE BEST WAY. You should be happy for the opportunity. Let California and Vermont and New York go single payer. Show us how it's done. I want to see it.
Posted on 9/21/17 at 9:24 pm to frogtown
quote:Which shows the problem with the whole system at its core.
You can't charge a 30 year old $350 a month premium and expect him/her to pay. This is why Obamacare is blowing up. You mandated the hell out of it making it so expensive that young people can't afford it. They would rather pay the penalty. Obamacare has created risk pools with too many sick/elderly. That is why some states are seeing 30% yoy premium increases. There is one county in Virginia with an 81% increase this year. Do some fricking research on why your beloved Obamacare is failing.
I'm against the individual mandate, on principle, but fewer and fewer people took the penalty so it's possible that it did work as an incentive. In addition, although it was a net loss in terms of penalty payments and tax credits, they did offset the cost.
In other words, the individual mandate seemed like a necessary evil to the terrible core system in place. I don't see how the terrible core, minus that necessary evil, will make anything better.
So we need to get ride of the terrible core, and this doesn't do it.
Posted on 9/21/17 at 9:25 pm to frogtown
quote:No. They should he forced to prove it without a terrible policy. That's how government can actually function somewhat effectively.
Here is the deal. Graham/Cassidy allows left wingers the opportunity to prove YOUR WAY IS THE BEST WAY. You should be happy for the opportunity. Let California and Vermont and New York go single payer. Show us how it's done. I want to see it.
Posted on 9/21/17 at 9:26 pm to buckeye_vol
quote:
So taking one large pile of crap with one incompetent entity trying to make it less crappy, doesn't somehow become better when dividing it into 50 piles of crap and requiring 50 new, inexperienced, and equally or more incompetent entities to get to make it less crappy.
Have some faith dude. I have heard Govs like Scott Walker and Greg Abbott are licking their chops. They are itching to take on this problem. Let's see what they can do.
Posted on 9/21/17 at 9:50 pm to frogtown
quote:
Do you realize why premium costs are spiraling out of control in the individual market?
A) they're not
B) a substantial cause of the 2018 increase is Republican sabotage of the ACA
Posted on 9/21/17 at 9:55 pm to bonhoeffer45
quote:
You won't see me saying the ACA is perfect, or that there isn't a problem of people in the middle that don't qualify for subsidies, that can't afford premiums or their deductibles. I was in that number for a period of time.
Color me shocked.
Posted on 9/21/17 at 9:58 pm to NC_Tigah
quote:
Let's be crystal clear. If someone shows up with an emergency in my emergency room, he/she/they will be cared for as if they were Leon Levine, Sandra Levine, or Bill Gates. Sorry, that's just the way it is, regardless of any legislation.
Nope it was shitty legislation that caused that to happen.
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay.
It is one of the main causes of our high healthcare costs because of millions of people taking advantage and scamming the system.
Posted on 9/21/17 at 10:18 pm to bonhoeffer45
quote:
Maybe calm down a bit, take it off caps lock, and start putting as much skepticism in Cassidy as you do toward Obama, and you will begin to see why this bill is so farcical.
Obamacare is crushing a lot of people. Everybody buying policies on the individual market and not getting a subsidy is getting hammered. I have a reason to be the way I am.
Previous to 2014 I could buy a high deductible catastrophic policy for $120 a month. The ACA mandates kicked in at the beginning of 2014. Aetna informed me my current policy did not comply with ACA. My new bronze level compliant policy would be $325 month. That told me everything I needed to know. It told me that my huge increase was mandate driven. It also told me my increase was there to help pay for someone else(what you socialists like to call it "cost sharing"). Fast forward to 2017 my payment would have been $454 a month. I didn't buy. I went without insurance.
I am almost sure premiums for me in 2018 will be north of $500 month. I am healthy, go to the gym and don't get sick. Why the frick would I pay $500 a month for something I don't use.(for those doubting these prices PLEASE get on the ACA Exchange and go see for yourself).
I don't want a subsidy. I make too much money and would not accept it anyway. I want to be able to to back to buying a high deductible catastrophic policy with a health savings account again. But I can't do that. Obamacare has "outlawed" those plans.
You Democrats live in your bubble. You have no clue what you have done. There were better ways to fix these problems then pass Obamacare. You are all a bunch of clowns to me...trying to redistribute wealth to fix problems but always creating more.
Graham/Cassidy will allow me to buy high deductible catastrophic health insurance without the mandates. That is what I want. And that has been the plan all along with the GOP. They know what the problem is. I won't be skeptical.
Posted on 9/21/17 at 10:23 pm to texashorn
quote:
Color me shocked.
What is shocking to you?
Most of American businesses are small businesses. And the way our US healthcare system is organized around, which is built around subsidizing large employer coverage and various entitlements for particular groups of people(very poor, old, veterans, lower income), many small businesses are often seeking their coverage through the individual market due to any number of reasons. Some just because the person is the sole employee. Like an electrician, carpenter, handyman etc.
I spent some time involved with one doing financial services for other local small businesses. In that time I purchased my coverage through the individual market.
Posted on 9/21/17 at 10:27 pm to frogtown
quote:
Everybody buying policies on the individual market and not getting a subsidy is getting hammered
That's, at most, 3% of the population.
Graham-Cassidy deprives 32M Americans of access to care, and harms many millions more with the elimination of protections for PECs and reduction in EHBs.
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