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Repeal of Obamacare
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besson3c
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Dec 30, 2016, 03:00 PM
 
So, conservatives, a simple question:

Will you be frustrated/annoyed/whatever if Obamacare is repealed without its replacement ready to go?
     
reader50
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Dec 30, 2016, 04:38 PM
 
It will be a shame losing all those employees as injuries happen. Could be bad for business.

Everyone needs medical care eventually. You either get it, or you die (or cannot work). I'm not sure why many conservatives oppose the ACA - it certainly isn't bad for insurance companies. They get more business. And there are fewer disabled workers on social assistance programs.

If it's repealed without a replacement, then we go back to the pain for lower-income families. They can get medical care once. At the cost of their home, car, and credit score.
     
ghporter
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Dec 30, 2016, 08:09 PM
 
My read of the overall results of Obamacare is that more people were able to stay working, especially those in very low paying jobs. Less time lost to illness - particularly without sick pay - means LOWER costs for business. It's expensive to train the new people you have to hire because you fired the guy that didn't have health insurance and wound up getting really, really sick because he couldn't afford to go to a doctor.

Cynically, but profit-oriented, Obamacare is actually good for business.

Glenn -----OTR/L, MOT, Tx
     
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Dec 31, 2016, 12:50 AM
 
There are many pro business reasons for good healthcare, most notably that preventative health care is much, much cheaper than having to wait until the hospital has to take your case, regardless of your insurance status. It also lowers the cost per capita as well as the cost as a percentage of GDP which are significantly higher than in other first world countries:


(Graphics taken from here.)

Some economists argue that being sure to have health insurance also encourages people to start businesses, because they no longer have to take the risk the health of their family in case things go sour. Or they enable more people to be a productive member of society (e. g. in case of chronic diseases, including mental illnesses). On the downside, we'd never have Breaking Bad

That is all in addition to non-economic arguments: no matter how safety-oriented we live, we will eventually need some form of health care, at birth (and for women during childbirth), close to death and in case of accidents or severe illness. Many of these costs are statistically speaking very predictable, and aren't going to go away. Unless you advocate for people to be thrown out of hospital, society needs to find a way to pay for all of this, no matter the system.
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ghporter
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Jan 2, 2017, 08:48 PM
 
Here's a (what I think of as) good argument for ensuring low-wage workers have health coverage: food service workers can do some VERY bad things to your business if they appear to be ill. And of course having only 3 out of 8 people working the counter and grill (because the other 5 are sick) can also do bad things for your business. So ensuring your (trained, experienced) workforce is available to work means that you can get your business done, and keeping acceptable staffing levels keeps your customers coming back.

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The Final Dakar
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Jan 3, 2017, 11:57 AM
 
Good idea besson, I’ve been wanting to touch on this for a while.

Repealing the ACA without passing a replacement is bullshit of the highest order. The GOP has been campaigning for this moment for six years, saying they will repeal & replace. If they don’t have a plan after six years, what have they been doing?

Second, if they repeal it but then give it a multi-year sunset, that’s cowardly and misguided. We already did something like this with the budget and when Congress couldn’t agree on what to do we got hit by sequestration. This time, if the GOP led congress can't get its shit together, millions will lose health insurance. What a great gamble.

Also, don’t be fooled by congressional wording on the issue. They’re promising to deliver ‘access’ to coverage instead of actual coverage. Ask yourself how useful access is if you can’t afford it. This entire charade is a big bowl of nothing. No one is guaranteeing that the ACA replacement will cover those with preexisting conditions, nor keep kids on their parent’s insurance post-college. And call me cynical, but the state-lines insurance barrier is a red herring of epic proportions. The free-market had 30 years to solve these problems, but nothing happened until the ACA.

Of course, the irony here is the stories of GOP voters who are covered under the ACA, voted Republican, but hoped they won’t take away their health insurance (See: Kentucky).

My 2¢
     
besson3c  (op)
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Jan 4, 2017, 10:48 PM
 
Agree Dakar!
     
OAW
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Jan 4, 2017, 11:11 PM
 
Originally Posted by The Final Dakar View Post
Of course, the irony here is the stories of GOP voters who are covered under the ACA, voted Republican, but hoped they won’t take away their health insurance (See: Kentucky).

My 2¢
You'll have to excuse me if I am less than sympathetic to those who willfully put themselves in this position.

OAW
     
Snow-i
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Jan 5, 2017, 02:56 PM
 
The ACA addressed the wrong problems with the industry. It does not matter who ends up paying when the costs are untenable (especially when passed onto small businesses).

We ought to be looking to control costs, not shift around who ends up paying (which is what the ACA does). The ACA is not pro-business, as it does not do anything to lower costs (or cost curves). The last debate I got into about the ACA was with OAW who was emphatic that despite the Obama's admin's promises, it was never supposed to lower costs.

How do we control costs?
-Get rid of the 50 different administrations and open up cross-state competition for insurance.
-Decouple health insurance from employment (this will not happen overnight, but we should start moving in that direction now).
-Incentivize the end-users to shop around on price for routine, preventative, and minor care (this is one the biggest driver of out of control costs - when "insurance" pays for everything there is no reason to look at costs on an individual level).
-Malpractice tort reform (in order to filter out frivolous and baseless lawsuits which cost the provider's a fortune through their own malpractice insurance)
-Set up separate safety nets for the uninsurable (pre-existing conditions) that are funded separately from the insurance market at large. The ACA here tried to roll those costs into the insurance market as a whole, which defeats the purpose of insurance as a whole (when the outcome is already known it is no longer insurance, but instead cost management).

Just my .02
     
OAW
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Jan 5, 2017, 04:31 PM
 
Originally Posted by Snow-i View Post
The ACA addressed the wrong problems with the industry. It does not matter who ends up paying when the costs are untenable (especially when passed onto small businesses).

We ought to be looking to control costs, not shift around who ends up paying (which is what the ACA does). The ACA is not pro-business, as it does not do anything to lower costs (or cost curves). The last debate I got into about the ACA was with OAW who was emphatic that despite the Obama's admin's promises, it was never supposed to lower costs.
Indeed we did but our disagreement was about what was actually meant by "lower costs". In other words, "lower costs" for who and in what form? My contention then and now is that it was NOT designed to "lower costs" for consumers in the form of lower insurance premiums in the future compared to what they pay today. Instead it was designed to "lower costs" for the federal government ... by slowing the rate of growth of those costs that it would have to foot the bill for. Or to put it another way, it was designed to make future federal spending on healthcare lower than it otherwise would have been if the ACA were not in effect. And it has been successful in that endeavor.



Originally Posted by Snow-i View Post
How do we control costs?
-Get rid of the 50 different administrations and open up cross-state competition for insurance.
Agreed! This is the dumbest thing we do WRT to health insurance.

Originally Posted by Snow-i View Post
-Decouple health insurance from employment (this will not happen overnight, but we should start moving in that direction now).
Agreed!

Originally Posted by Snow-i View Post
-Incentivize the end-users to shop around on price for routine, preventative, and minor care (this is one the biggest driver of out of control costs - when "insurance" pays for everything there is no reason to look at costs on an individual level).
Agreed! But the problem with this is that insurance companies fundamentally act against this with their "In Network" vs "Out of Network" shenanigans.

Originally Posted by Snow-i View Post
-Malpractice tort reform (in order to filter out frivolous and baseless lawsuits which cost the provider's a fortune through their own malpractice insurance)
Agreed!

Originally Posted by Snow-i View Post
-Set up separate safety nets for the uninsurable (pre-existing conditions) that are funded separately from the insurance market at large.
The ACA here tried to roll those costs into the insurance market as a whole, which defeats the purpose of insurance as a whole (when the outcome is already known it is no longer insurance, but instead cost management).
I'm going to disagree on this one. The name of the game with insurance is having a sufficiently diversified risk pool. Young and elderly. Male and female. Healthy and ill. Etc. To segregate the chronically ill into its own risk pool would be totally at odds with this. And naturally it would be completely unaffordable without government subsidies. So if the government is going to have to foot the bill for the sickest among us anyway why not just do the sensible thing like every other advanced nation does and provide universal health insurance by the government? Otherwise known as "Medicare for All" in the US. No more primary private health insurance market. That would be handled by the government. All US citizens would be covered so you can't get a more diverse risk pool than that. And all US taxpayers would pay the premium to Uncle Sam instead of Aetna, Anthem, United Healthcare, etc. Private insurance companies could participate in the secondary health insurance market with plans that consumers could optionally purchase. Just as they do with plans that cover costs that Medicare doesn't cover for the elderly. This checks all the boxes IMO. One set of rules and regulations instead of 50. It decouples health insurance from one's job. Everyone is covered including those with pre-existing conditions. You have the most diverse risk pool possible so costs are spread out over the entire population thereby minimizing individual premiums. No more "In Network" vs "Out of Network" BS so people can actually shop around for healthcare providers without restriction. And even better ... the federal government can use its volume purchasing power to control if not actually lower costs ... especially with respect to prescription drug prices, surgical procedures, etc.

Just my 2 cents.

OAW
     
Snow-i
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Jan 5, 2017, 05:19 PM
 
Originally Posted by OAW View Post
Indeed we did but our disagreement was about what was actually meant by "lower costs". In other words, "lower costs" for who and in what form? My contention then and now is that it was NOT designed to "lower costs" for consumers in the form of lower insurance premiums in the future compared to what they pay today. Instead it was designed to "lower costs" for the federal government ... by slowing the rate of growth of those costs that it would have to foot the bill for. Or to put it another way, it was designed to make future federal spending on healthcare lower than it otherwise would have been if the ACA were not in effect. And it has been successful in that endeavor.





Agreed! This is the dumbest thing we do WRT to health insurance.



Agreed!



Agreed! But the problem with this is that insurance companies fundamentally act against this with their "In Network" vs "Out of Network" shenanigans.



Agreed!



I'm going to disagree on this one. The name of the game with insurance is having a sufficiently diversified risk pool. Young and elderly. Male and female. Healthy and ill. Etc. To segregate the chronically ill into its own risk pool would be totally at odds with this. And naturally it would be completely unaffordable without government subsidies. So if the government is going to have to foot the bill for the sickest among us anyway why not just do the sensible thing like every other advanced nation does and provide universal health insurance by the government? Otherwise known as "Medicare for All" in the US. No more primary private health insurance market. That would be handled by the government. All US citizens would be covered so you can't get a more diverse risk pool than that. And all US taxpayers would pay the premium to Uncle Sam instead of Aetna, Anthem, United Healthcare, etc. Private insurance companies could participate in the secondary health insurance market with plans that consumers could optionally purchase. Just as they do with plans that cover costs that Medicare doesn't cover for the elderly. This checks all the boxes IMO. One set of rules and regulations instead of 50. It decouples health insurance from one's job. Everyone is covered including those with pre-existing conditions. You have the most diverse risk pool possible so costs are spread out over the entire population thereby minimizing individual premiums. No more "In Network" vs "Out of Network" BS so people can actually shop around for healthcare providers without restriction. And even better ... the federal government can use its volume purchasing power to control if not actually lower costs ... especially with respect to prescription drug prices, surgical procedures, etc.

Just my 2 cents.

OAW
Glad we agree on so many points. I think it's a great start to making healthcare available and affordable to everyone.

A couple points though (in the interest of honest discussion).
Can you tell me what the practical difference is between costs to the federal government and costs to society at large (who happens to fund 100% of federal government)? Shifting who pays doesn't actually lower costs - nor does it have any practical effect on the market or it's trends. The problem is, when you have a condition, you are no longer part of a risk pool - you are now part of the cost burden. Treating (paying for) people with pre existing conditions as a "risk" is like buying car insurance the day after your accident - there's no risk of an accident because it's already happened. You are now part of the cost burden, not the risk pool. I'm saying we ought to find a way to fund that so that the "insurance" part of the market is still "insurance" and not "cost management". That same cost burden is what we need to make more efficient (not just find ways to fund, which is what you're suggesting). Though we still need to fund it, the solution lies in reducing that cost burden so that the same amount of money treats more people with better care. By simply spreading around the costs so that healthy people are subsidizing the sick, you are disincentivizing people from the behaviors that lower risk (and therefore ultimately cost).
     
The Final Dakar
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Jan 5, 2017, 05:28 PM
 
Perhaps I'm missing something, but I feel like a few of you didn't address the OP's question:
Originally Posted by besson3c View Post
Will you be frustrated/annoyed/whatever if Obamacare is repealed without its replacement ready to go?
I'm not here to try and wrangle what good policy is (That's been done to death).

I'm here to see whether people think the current GOP strategy for repeal now then replace replace later is good governance.
     
ghporter
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Jan 5, 2017, 05:35 PM
 
The most substantial things in Obamacare are:
Mandatory coverage of preexisting conditions
Mandatory coverage for mental health issues
PRICE TRANSPARENCY - this is the really hugest point.

Since customers could actually comparison shop, a lot of expensive, "low bang for the buck" plans (that made stockholders rich while shafting customers) stopped making money. That's when the insurance companies started saying they were not making money. They were, just not in the number of truckloads they were used to making.

These three things MUST be preserved. Essentially pauperizing a family because of a condition that they couldn't prevent (let's talk birth defects, as an example) is not OK. Not covering mental health services leads to all sorts of very bad things, from homeless people with psychosis who are a huge drain on society to people who wind up committing big headline offenses (drive into a crowd because the voices tell you to?). And finally, price transparency must be maintained because it will help both customers AND insurers. Crappy plans should die, period. How does the marketplace make that happen if not through price transparency?

Glenn -----OTR/L, MOT, Tx
     
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Jan 5, 2017, 05:57 PM
 
Originally Posted by Snow-i View Post
The ACA addressed the wrong problems with the industry. It does not matter who ends up paying when the costs are untenable (especially when passed onto small businesses).
I think Obama was hobbled by what was politically feasible here. Not making sure that everyone is enrolled in health care means that the people for which health care is cheap (e. g. 20-35 year-olds) tend to be out of the mix, and this is one of the factors why the costs on average went up. Health insurance is only cheap if also the healthy are insured.
Originally Posted by Snow-i View Post
How do we control costs?
-Get rid of the 50 different administrations and open up cross-state competition for insurance.
Agreed, and that would make it easier for insurance companies, too, because they'd automatically be able to sell into 50 states. Health care is an industry where economies of scale really work in our favor — if we let it. It'd also put the state and insurance companies in a much more powerful position to demand good prices from the pharmaceutical companies.

I would add another big one:
- Invest in prevention and make preventative health care free, e. g. free mammographies for women in a certain age range. You could even offer people who are up to date with all recommended check-ups a rebate.

Oh, one last bit: when we say low cost, I think it is important to think of low costs to society as opposed to low cost for companies. The bulk of a person's health care costs is during periods when that person isn't gainfully employed (i. e. during birth and in the last years before death as well as during child birth for women). Companies depend on a healthy society, and what may be cheaper in the short term can incur huge long-term costs. Japan's crazy work culture and lack of career paths for women, for instance, has contributed significantly to the worker shortage (there are 140 jobs for 100 people). The lack of workers creates even stronger incentives for companies to have employees work long hours — which leads to even less children.
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Snow-i
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Jan 5, 2017, 06:05 PM
 
Originally Posted by ghporter View Post
The most substantial things in Obamacare are:
Mandatory coverage of preexisting conditions
Mandatory coverage for mental health issues
PRICE TRANSPARENCY - this is the really hugest point.

Since customers could actually comparison shop, a lot of expensive, "low bang for the buck" plans (that made stockholders rich while shafting customers) stopped making money. That's when the insurance companies started saying they were not making money. They were, just not in the number of truckloads they were used to making.

These three things MUST be preserved. Essentially pauperizing a family because of a condition that they couldn't prevent (let's talk birth defects, as an example) is not OK. Not covering mental health services leads to all sorts of very bad things, from homeless people with psychosis who are a huge drain on society to people who wind up committing big headline offenses (drive into a crowd because the voices tell you to?). And finally, price transparency must be maintained because it will help both customers AND insurers. Crappy plans should die, period. How does the marketplace make that happen if not through price transparency?
The issue of price transparency would be self correcting if the end-user had to start considering price when shopping for insurance and again when they need routine, minor, or elective care. When the employer pays the premiums, and when the end-user never even sees the real bill for care, you get what you're talking about. The end-user is completely disconnected from the cost of the care they are purchasing.

Pre-existing conditions de facto do not qualify for insurance. Forcing insurance companies to manage the costs of the uninsurable is like using a hammer to stitch up a would. That's why I am saying we need another mechanism with which to manage those costs (and I'll be clear I am NOT suggesting we leave those people out in the cold - simply saying we need another mechanism to account for their costs). People should not be pauperized for health care costs out of their control - the only real solution we have is to lower those costs (instead of shuffling around who's paying). I think if we want to start seeing the price of care drop, our only course is to foster the aspects of the market which cause those costs to drop.

With due respect, there is a reason so many insurance companies dropped out of the exchanges, and that reason boils down to costs. I'm saying, take those costs out of the equation for insurance and find another way to pay for them that encourages lower real costs for the same services. The system we have now (ACA) does nothing to encourage lower real costs of caring for sick people (it simply shifts who ends up paying for the care).

I agree with your point on mental health services.
     
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Jan 5, 2017, 06:11 PM
 
I can't get the image to display properly, but click here you'll see what I mean with the ACA and costs.

http://data.worldbank.org/indicator/...=US&start=2008
     
Snow-i
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Jan 5, 2017, 06:25 PM
 
Originally Posted by OreoCookie View Post
I think Obama was hobbled by what was politically feasible here. Not making sure that everyone is enrolled in health care means that the people for which health care is cheap (e. g. 20-35 year-olds) tend to be out of the mix, and this is one of the factors why the costs on average went up. Health insurance is only cheap if also the healthy are insured.
You're talking about what an individual can expect to pay for premiums each month - more people who never use insurance or do so lightly would of course lower the cost for the rest as it would bring down the average cost of care per person. I'm saying we're looking at the wrong numbers.

I'm way oversimplifying the equation here, but it essentially boils down to X = number of people insured and Y=total cost of all care for those people. The insurance premium is essentially Y/X, where in the ACA format we are adding numbers to X without significantly increasing Y - this results in a lower cost for per X (hence a lower premium for an individual). I'm saying we need to tackle the Y number (the aggregate, absolute real cost of care) if we want to solve our healthcare problems long term. A lower Y means a lower "per X" (premium) by default, with the added benefit of more access, a healthier economy, and better quality care (provided reducing quality isn't how we arrive at a lower Y).
     
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Jan 5, 2017, 06:33 PM
 
Originally Posted by Snow-i View Post
Glad we agree on so many points. I think it's a great start to making healthcare available and affordable to everyone.


Originally Posted by Snow-i View Post
A couple points though (in the interest of honest discussion).
Can you tell me what the practical difference is between costs to the federal government and costs to society at large (who happens to fund 100% of federal government)? Shifting who pays doesn't actually lower costs - nor does it have any practical effect on the market or it's trends.
But that's exactly what this graph is showing. It reflects National Healthcare Spending Projections. Across the board for our society at large. And it indicates that those projections are lower post-ACA than they were pre-ACA. Naturally the federal governments portion of those overall costs would be a subset. And I could certainly find some graphs for federal deficit projects pre-ACA and post-ACA. But I think we should respect the topic of this particular thread and not go off on that particular tangent.



Originally Posted by Snow-i View Post
The problem is, when you have a condition, you are no longer part of a risk pool - you are now part of the cost burden. Treating (paying for) people with pre existing conditions as a "risk" is like buying car insurance the day after your accident - there's no risk of an accident because it's already happened. You are now part of the cost burden, not the risk pool. I'm saying we ought to find a way to fund that so that the "insurance" part of the market is still "insurance" and not "cost management".
But an insurance risk pool reflects both those members who are healthy and are therefore potential cost burdens as well as those who are already sick and therefore actual cost burdens. Everyone is paying into the collective pot. But only some are drawing funds out of that pot. The reason it's important to have a diversified risk pool is to ensure that there's enough revenues generated to cover the expenses incurred. The entire point of a "risk pool" is to spread the financial risk evenly among a large number of contributors to the program.

Originally Posted by Snow-i
That same cost burden is what we need to make more efficient (not just find ways to fund, which is what you're suggesting). Though we still need to fund it, the solution lies in reducing that cost burden so that the same amount of money treats more people with better care. By simply spreading around the costs so that healthy people are subsidizing the sick, you are disincentivizing people from the behaviors that lower risk (and therefore ultimately cost).
Reducing actual healthcare costs charged by providers is a different matter as you have indicated. And there are a lot of "headwinds" involved in such an endeavor. Promoting competition is always a good thing. But quite unlike buying t-shirts healthcare services don't have significant demand price elasticity. A parent who has a toddler running a fever simply isn't going to "shop around" for a doctor who has the best price. And generally speaking, most people don't consider primary healthcare providers to be a "commoditized" market. There's a history and level of trust that people develop with their physicians over time. It's not something where people will say Coke will do if you don't have Pepsi available. Additionally, since we have a capitalist economy the government is limited in what it can do with respect to price controls. I think you would agree that if the federal government were to start regulating how much healthcare providers could charge for their goods and services the ideological right would collectively set its hair on fire! It's a political non-starter. Maybe ... just maybe ... the GOP could be convinced that it made a colossal mistake when it forbade the federal government by law from utilizing its volume purchasing power to negotiate lower prices on prescription drugs provided by the Medicare Part D program they passed. But given the political climate that's probably about the only thing that's even remotely viable on this front.

OAW
     
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Jan 5, 2017, 08:03 PM
 
Originally Posted by Snow-i View Post
You're talking about what an individual can expect to pay for premiums each month - more people who never use insurance or do so lightly would of course lower the cost for the rest as it would bring down the average cost of care per person. I'm saying we're looking at the wrong numbers.

I'm way oversimplifying the equation here, but it essentially boils down to X = number of people insured and Y=total cost of all care for those people. The insurance premium is essentially Y/X, where in the ACA format we are adding numbers to X without significantly increasing Y - this results in a lower cost for per X (hence a lower premium for an individual). I'm saying we need to tackle the Y number (the aggregate, absolute real cost of care) if we want to solve our healthcare problems long term. A lower Y means a lower "per X" (premium) by default, with the added benefit of more access, a healthier economy, and better quality care (provided reducing quality isn't how we arrive at a lower Y).
I think we don't disagree here, but were just talking about different aspects: having more healthy people as part of the insurance system indeed lowers the cost per person. All things being equal, though, adding healthy people to the mix doesn't significantly increase the total necessary amount, i. e. Y would not have to increase by much if all you want is keep the current prices and level of coverage.

The cost Y is a hard one to judge, because we need to be clear that we include everything that is necessary in the costs. For instance, a lot of the mentally ill end up in prison, and on average it costs $30k-$60k per person to incarcerate someone. Add to that the cost of these people not working, and the damage is huge even if they appear as a net cost in the health care bracket if they were to receive adequate treatment. Friends of mine have receive expensive therapies for mental health-related issues, but now they are able to lead normal lives again and contribute to society. Calculating costs here is a tough political issue. What sticks out is that costs for the same types of standard exams are significantly cheaper in other first-world countries than they are in the US. I don't claim to know why, but it seems there is significant head room for lower prices as well for the same level of coverage.

Instead of determining Y in isolation, I propose to start from a differently:
(1) List the expected medical issue a person is to face statistically.
(2) Compute the current costs, including e. g. costs for incarcerating the mentally ill. These are the costs incurred by society, and it is these costs that you want to bring down when possible.
(3) Identify preventative measures for the most common ailments (including, say, obesity, diabetes, cardio-vascular problems, mental health issues, various forms of cancer, etc.). These preventative measures could include regular checkups for certain risk groups or cooking classes in school to combat obesity.
(4) Quantify potential savings of these preventative measures.

Only then I think we need to figure out what costs should be borne by the health care system. So if an out-patient therapy of a mental illness costs $20k per year but saves $50k in incarceration costs, that's a net benefit of $30k for society. Of course you are right that at the end of a day we need to come up with an averaged Y/X.
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Jan 6, 2017, 07:24 AM
 
So you vote for it before you can see whats in it?
     
besson3c  (op)
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Jan 6, 2017, 09:10 AM
 
Originally Posted by The Final Dakar View Post
Perhaps I'm missing something, but I feel like a few of you didn't address the OP's question:


I'm not here to try and wrangle what good policy is (That's been done to death).

I'm here to see whether people think the current GOP strategy for repeal now then replace replace later is good governance.

Thank you.
     
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Jan 6, 2017, 09:21 AM
 
I think it should be done piecemeal.
     
besson3c  (op)
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Jan 6, 2017, 09:25 AM
 
Originally Posted by BadKosh View Post
I think it should be done piecemeal.
What is "it"?
     
Laminar
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Jan 6, 2017, 09:30 AM
 
Originally Posted by BadKosh View Post
So you vote for it before you can see whats in it?
So you vote to repeal it before you can see what will replace it?
     
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Jan 6, 2017, 10:49 AM
 
Same level of incompetence. Start by removing restrictions on where an insurance company can sell. Get rid of the multi-layered gov't screwing around stuff that made it so expensive without actually addressing the costs of the health care (not the insurance).
     
besson3c  (op)
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Jan 6, 2017, 07:56 PM
 
So, conservatives, a simple question:

Will you be frustrated/annoyed/whatever if Obamacare is repealed without its replacement ready to go?
     
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Jan 6, 2017, 09:20 PM
 
Originally Posted by BadKosh View Post
I think it should be done piecemeal.
You can't implement such a substantial overhaul to the healthcare system change piecemeal.
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Jan 7, 2017, 03:39 AM
 
Originally Posted by Laminar View Post
So you vote to repeal it before you can see what will replace it?
You make it sound as if the system we had before was do disastrous that a reversion to it is somehow unacceptable. Yes, get rid of it - it doesn't work. Our system before ACA was still the best in the world by a large margin, and would still be even with today's standards. Did it have holes? Yes, but i think at this point were all for getting them patched. Do you really think the GOP is dumb enough to let the media run wild with headlines about people being denied healthcare? I don't think so.

The system needs fundamental reform. You don't do that from a starting point in the wrong direction.
     
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Jan 7, 2017, 11:36 AM
 
Originally Posted by Snow-i View Post
You make it sound as if the system we had before was do disastrous that a reversion to it is somehow unacceptable. Yes, get rid of it - it doesn't work. Our system before ACA was still the best in the world by a large margin, and would still be even with today's standards. Did it have holes? Yes, but i think at this point were all for getting them patched. Do you really think the GOP is dumb enough to let the media run wild with headlines about people being denied healthcare? I don't think so.

The system needs fundamental reform. You don't do that from a starting point in the wrong direction.

The best how?

Quality care for those that can afford it? If so, has this changed with the ACA? I say no.

Accessibility? Hell no.
     
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Jan 7, 2017, 08:49 PM
 
Originally Posted by Snow-i View Post
Our system before ACA was still the best in the world by a large margin, and would still be even with today's standards.
With respect, but it sounds like you don't really know what is going on in the world. I posted charts above that show that Americans actually pay the most compared to other industrialized countries — by a significant margin. So what does that buy you?

The US has below-OECD average life expectancy (see e. g. here or here). On average Americans don't live longer despite the extra spending.

The US has about twice the infant mortality than Japan or European countries (taken from the CIA factbook)

Standard procedures tend to be significantly more expensive (e. g. on average a hip replacement costs 4-5 times as much in the US). Ditto for childbirth — and that is despite the unusually high rate of C-sections (you can schedule a c-section, but not a birth, and C-sections are apparently more expensive nevertheless).

In what sense specifically do you think the US is better? Is it just better if you have the money to pay for it? Even if the health care level for rich countries is your focus, I think there are plenty of countries (e. g. private clinics in Mexico, Switzerland and Germany) that can stand toe-to-toe with any other hospital in the world.

Believing that the US had or perhaps still has the greatest health care system in the world is really a disservice, because then you really might be tempted to claim “it if ain't broken, don't fix it.”
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Jan 7, 2017, 10:32 PM
 
The distinction can be made between having the best DOCTORS and the best HEALTHCARE system. It varies from state to state, region to region. In MA, and most of New England, I feel very confident that our doctors are top quality. There is a reason medical hopefuls from other countries come here to study, intern, do their residencies. There is a reason all the best research comes from here, and is published here.

Insurance? Health corporations? Meh.

Whereas there are certain medical practices in FL that I wouldn't take my dog to. My folks moved there and tell some stories of malpractice, ineptitude, and general not giving a f*** by the medical personnel they've encountered. My mother is a retired nurse and had to instruct someone in properly taking her blood draw, ffs.
     
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Jan 8, 2017, 01:17 AM
 
Originally Posted by andi*pandi View Post
The distinction can be made between having the best DOCTORS and the best HEALTHCARE system.
And closely related is who has access to excellent doctors. In all developed countries you can find excellent doctors — as long as you are willing and able to pay for them, though.
I don't suffer from insanity, I enjoy every minute of it.
     
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Jan 9, 2017, 03:11 PM
 
Originally Posted by Snow-i View Post
You make it sound as if...
Wow, those are a lot of words shoved into my mouth.
     
The Final Dakar
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Jan 9, 2017, 04:08 PM
 
Originally Posted by Snow-i View Post
You make it sound as if the system we had before was do disastrous that a reversion to it is somehow unacceptable. Yes, get rid of it - it doesn't work. Our system before ACA was still the best in the world by a large margin, and would still be even with today's standards. Did it have holes? Yes, but i think at this point were all for getting them patched. Do you really think the GOP is dumb enough to let the media run wild with headlines about people being denied healthcare? I don't think so.

The system needs fundamental reform. You don't do that from a starting point in the wrong direction.
Is dismantling a system that covers 20 million people with no replacement unacceptable? Yes, I kind of think it is.

But then again that doesn't seem to be what the GOP is offering anyway. They are talking about a repeal with delayed sunset so they can come up with a solution that they somehow didn't do in the past six years.

So basically all they're offering is a symbolic gesture and uncertainty for 20 million people.
     
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Jan 9, 2017, 04:34 PM
 
Originally Posted by Laminar View Post
Wow, those are a lot of words shoved into my mouth.
Only the first sentence, and I'm not shoving anything into your mouth just repeating back my interpretation of your meaning. If I am off base, and as always, please help me understand your meaning if I have misinterpreted you.
     
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Jan 9, 2017, 09:01 PM
 
I was reading posts from a guy earlier who was cheering at the idea of Obamacare being repealed, then he mentioned how he was insured under the ACA and it was great and they shouldn't repeal the ACA, only Obamacare.
I have plenty of more important things to do, if only I could bring myself to do them....
     
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Jan 9, 2017, 09:45 PM
 
Originally Posted by Waragainstsleep View Post
I was reading posts from a guy earlier who was cheering at the idea of Obamacare being repealed, then he mentioned how he was insured under the ACA and it was great and they shouldn't repeal the ACA, only Obamacare.
And that right there is a PRIME EXAMPLE of how the intersection between right wing demagoguery and uninformed voters is likely to result in a whole lot of Trump supporters being in store for a rude awakening once they realize that they played themselves.

OAW
     
besson3c  (op)
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Jan 9, 2017, 10:25 PM
 
Originally Posted by The Final Dakar View Post
Is dismantling a system that covers 20 million people with no replacement unacceptable? Yes, I kind of think it is.

But then again that doesn't seem to be what the GOP is offering anyway. They are talking about a repeal with delayed sunset so they can come up with a solution that they somehow didn't do in the past six years.

So basically all they're offering is a symbolic gesture and uncertainty for 20 million people.

That's what kills me. You don't like the act? Fine, propose replacements, not just rhetoric. Can't get it passed? Fine, at least you tried and there is a framework to work with to iterate on for the next go around. Like... Now.
     
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Jan 10, 2017, 12:29 PM
 
Originally Posted by Snow-i View Post
Only the first sentence, and I'm not shoving anything into your mouth just repeating back my interpretation of your meaning
BadKosh made a typical dumb, short-sighted bumper-sticker comment and I responded in kind, except on topic for the thread.

I don't know where you got your interpretation of what I said.

Does this look like the best health system in the world by a wide margin:

- The leading cause of bankruptcy was medical bills
- You could be denied insurance coverage for having cancer or HIV, diabetes, or even acne
- Despite higher spending than any other country, patient outcomes are poor
     
The Final Dakar
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Jan 10, 2017, 01:16 PM
 
Originally Posted by Waragainstsleep View Post
I was reading posts from a guy earlier who was cheering at the idea of Obamacare being repealed, then he mentioned how he was insured under the ACA and it was great and they shouldn't repeal the ACA, only Obamacare.
I'm not buying this shit until I see more than a few images on twitter. And even if they're true I don't see any evidence that it's widespread. It's nice if you want to feel better about yourself in these troubling times, but otherwise it's worthless. I don't see it being enough to start a backlash against the GOPs current plans.
     
The Final Dakar
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Jan 10, 2017, 01:19 PM
 
I think some of the more shocking developments is Rand Paul is against Repeal & Wait, as is the conservative AEI.
     
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Jan 10, 2017, 05:29 PM
 
I don't think you'll get an answer, so I'll answer for them: "Yes, it frightens me, especially if I'm a woman, but I can't say otherwise because of political tribalism."
"…I contend that we are both atheists. I just believe in one fewer god than
you do. When you understand why you dismiss all the other possible gods,
you will understand why I dismiss yours." - Stephen F. Roberts
     
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Jan 11, 2017, 03:14 PM
 
Originally Posted by OAW View Post
And that right there is a PRIME EXAMPLE of how the intersection between right wing demagoguery and uninformed voters is likely to result in a whole lot of Trump supporters being in store for a rude awakening once they realize that they played themselves.

OAW
You guys found an idiot. I don't understand how you can take one idiot and say "SEE!? I WAS RIGHT!"

I'll see your idiot, and raise you another:
https://www.youtube.com/watch?v=Bg98BvqUvCc

There's no shortage of them in our society.
     
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Jan 11, 2017, 03:25 PM
 
Originally Posted by Laminar View Post
BadKosh made a typical dumb, short-sighted bumper-sticker comment and I responded in kind, except on topic for the thread.

I don't know where you got your interpretation of what I said.
Fair enough. I was trying to address the OT

Does this look like the best health system in the world by a wide margin:

- The leading cause of bankruptcy was medical bills
- You could be denied insurance coverage for having cancer or HIV, diabetes, or even acne
- Despite higher spending than any other country, patient outcomes are poor
[/quote]
From your last source: "Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions." The article then goes on to state that despite this extra spending, we don't rank where we shuold on life expectancy and other key metrics when compared to other high income nations.

So we know that the root problem isn't who or how often people are using care - hence why the ACA does not address the root problem with our healthcare today. The fact that we are able to spend more regardless of the effectiveness of that spending is my point. Let's make those same (or hopefully fewer) dollars (my Y metric from earlier in this thread) can access that technology. In the same breath, the ability to spend more is exactly why we need more healthcare in the first place, considering we spend shit tons money on all kinds of things that kill us (cars, smoking, obesity, skiing accidents, etc). When you aren't the one footing the real bill, aren't you always going to ask for the very best tech available regardless of your need? Yes. How do we drop those prices? By making the end-user of the care cost conscious. Not by forcing healthy people who don't need care to purchase plans they have no need for (or plans that cover far more than they need). My indictment of the ACA has always been this - it only addresses who's paying not how much the real cost is.
     
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Jan 11, 2017, 03:43 PM
 
The end user isn't qualified to know Level of treatment he or she needs.

I also can't think of something less fun and more stressful than trying to comparison shop ****ing health treatments. As if our healthcare system wasn't stressful enough already.

How do I know whether I need an MRI by how much it costs?
     
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Jan 11, 2017, 03:48 PM
 
Originally Posted by Snow-i View Post
There's no shortage of them in our society.

Thats precisely our point.
I have plenty of more important things to do, if only I could bring myself to do them....
     
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Jan 11, 2017, 04:06 PM
 
Originally Posted by Snow-i View Post
You guys found an idiot. I don't understand how you can take one idiot and say "SEE!? I WAS RIGHT!"

I'll see your idiot, and raise you another:
https://www.youtube.com/watch?v=Bg98BvqUvCc

There's no shortage of them in our society.
But this doesn't seem to be a "one-off" type of situation. There are a LOT of Trump supporters who have directly benefited from the ACA.

Why Obamacare enrollees voted for Trump
In Whitley County, Kentucky, the uninsured rate declined 60 percent under Obamacare. So why did 82 percent of voters there support Donald Trump? | Vox.com


OAW
     
andi*pandi
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Jan 11, 2017, 05:06 PM
 
I think that lady was taken out of context, cut so that it implied she thought she'd get free gas and mortgage, when like most people she was likely just hoping the economy would rebound so she'd keep her job and be able to pay it herself. Like you do.
     
OAW
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Jan 11, 2017, 05:30 PM
 
Well I predict one of two things is going to happen.

1. A whole lot of working class Trump voters who gained health insurance under the ACA will be ass out if it gets repealed without a suitable replacement.

2. A whole lot of working class Trump voters who gained health insurance under the ACA will end up in the same boat because the "replacement" will essentially be "Obamacare" under a different name. Therefore it'll be the greatest thing since sliced bread for them. Sort of how like the economy sucked until Trump was elected POTUS. Then all of a sudden the economy with the exact same underlying fundamentals is magically doing so much better.

OAW
     
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Jan 11, 2017, 06:39 PM
 
Originally Posted by Snow-i View Post
... considering we spend shit tons money on all kinds of things that kill us (cars, smoking, obesity, skiing accidents, etc). ... How do we drop those prices? By making the end-user of the care cost conscious.
Somehow I don't think being charged more for health insurance will influence what people buy or do. When shopping for a car, I didn't consider health costs at all, and doubt skiers would turn around and head back to the den if reminded of the risks. Health costs do work somewhat on smoking, not so well on obesity.

However, transferring more health costs to end users (ie - forcing higher deductibles & higher monthly premiums) just prices working poor out of the system. Which translates into more people permanently unable to work and higher death rates among working poor. Plus higher ER costs to stabilize emergency cases. Who are not fixed enough to work, only stabilized enough to push back out on the street.

Requiring health coverage across the board isn't the most ideologically pure answer, agreed. It forces low-risk people to pay in. However, all those people *will* eventually need coverage as they get older, so it can be considered a pay-in-now, get-back-later deal. And it's far preferable to leaving problems unaddressed.
     
 
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