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Repeal of Obamacare (Page 5)
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Snow-i
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Mar 1, 2017, 04:45 PM
 
Originally Posted by Waragainstsleep View Post
I thought it did help with that by allowing hospitals or health authorities (I'm not sure what the relevant organisational units are called) to band together and purchase supplies in bulk? Not sure where I read that, it was ages ago.
It imposed a medical device tax which just about every person in the industry opposed. That was backed off, but the main problems as I seem them are in the 50 different sets of regulations an insurance company must account for in order to serve a nationwide customer base.

That would be a quick way to save a metric ton of $$$. Where you needed 50 lawyers before now you need one.
     
Snow-i
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Mar 1, 2017, 04:46 PM
 
Originally Posted by Waragainstsleep View Post
How can a government program reduce staffing costs without huge subsidies? The GOP isn't going to stand for that.

Having glanced at a few American medical bills online it seems like there is a culture similar to the automotive repair industry where the contractor who knows an insurance company is paying jacks prices through the roof. thousands or tens of thousands for a scan seems extortionate.

Surprised no-one has outsourced scan based diagnoses to India yet.
Subsidies don't reduce costs. They only change who is paying.
     
Snow-i
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Mar 1, 2017, 04:58 PM
 
Originally Posted by Laminar View Post
Is there a solution to this that doesn't involve single payer? Note that I don't count telling someone with a sick kid to "shop around and negotiate for the best price" as a solution.
I believe so. As I alluded to in my above, we could start by standardizing the regulation - where a current insurance company has to have state-specific plans that adhere to state-specific regulations and laws, you could open it up and allow companies to sell plans across state lines. This would greatly reduce the administrative and actuarial burden imposed to health insurance providers.

The next biggest line item? Tort costs. Malpractice insurance is skyrocketing which means the cost of service is also skyrocketing. We need to find a way to streamline the process of malpractice and consider giving doctors a form of qualified immunity so long as they follow a set of standards, instead of adjudicating each case according to common law. Fringe cases cost millions, even if the plaintiff loses. As part of this, we need a recourse for cases of actual malpractice.

Further? Throw out this "in network out of network" bullshit. The fact that the same service at a doctors office costs different amounts based on who's paying is completely backwards, and obfuscates real costs behind administrative inefficiency and disconnects the ultimate-buyer from that cost.

Make health insurance closer to actual insurance, meaning routine care and standard procedures are paid out of pocket without the involvement of insurance. If you need a specialist, that's covered. If you need anything other than preventative or standard diagnostic care, that's covered. If you need to talk to your doctor about that zit that just won't go away? You shouldn't involve "insurance" in that. Incentivize the masses by encouraging HSA's and offering other tax benefits to medical spending. This will drive down the cost of routine care as price will now be a consideration for the masses when choosing a doctor. As part of this, with to address your "sick kid scenario" - the visit itself and the standard diagnostics would be paid for by the end user. Anything above and beyond would be covered, including the treatment. If the person involved is not able to cover the $40-$100 it should cost for the standard part of the care, we'll need to look at a safety net for the poverty stricken.

I've got a few more ideas, but we can start here.
     
Snow-i
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Mar 1, 2017, 05:06 PM
 
Originally Posted by Snow-i View Post
It imposed a medical device tax which just about every person in the industry opposed. That was backed off, but the main problems as I seem them are in the 50 different sets of regulations an insurance company must account for in order to serve a nationwide customer base.

That would be a quick way to save a metric ton of $$$. Where you needed 50 lawyers before now you need one.
Sorry, it was delayed for two years. Still around

https://www.irs.gov/uac/medical-devi...sked-questions
     
OAW
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Mar 1, 2017, 05:41 PM
 
Originally Posted by Snow-i
...the main problems as I seem them are in the 50 different sets of regulations an insurance company must account for in order to serve a nationwide customer base.
Originally Posted by Snow-i
Subsidies don't reduce costs. They only change who is paying.
Originally Posted by Snow-i
Further? Throw out this "in network out of network" bullshit. The fact that the same service at a doctors office costs different amounts based on who's paying is completely backwards, and obfuscates real costs behind administrative inefficiency and disconnects the ultimate-buyer from that cost.


Originally Posted by Snow-i
Make health insurance closer to actual insurance, meaning routine care and standard procedures are paid out of pocket without the involvement of insurance. If you need a specialist, that's covered. If you need anything other than preventative or standard diagnostic care, that's covered. If you need to talk to your doctor about that zit that just won't go away? You shouldn't involve "insurance" in that. Incentivize the masses by encouraging HSA's and offering other tax benefits to medical spending. This will drive down the cost of routine care as price will now be a consideration for the masses when choosing a doctor. As part of this, with to address your "sick kid scenario" - the visit itself and the standard diagnostics would be paid for by the end user. Anything above and beyond would be covered, including the treatment. If the person involved is not able to cover the $40-$100 it should cost for the standard part of the care, we'll need to look at a safety net for the poverty stricken.
And now this is a bridge too far. This is one of those things that sounds good in theory but in practice it simply isn't realistic. For one very simple reason ...

If your savings account balance is looking sad, you're not alone.

According to a 2016 GOBankingRates survey, 69% of Americans have less than $1,000 in their savings accounts.

What's more, 34% have no savings at all:


While the numbers seem staggering, it shouldn't come as a huge surprise, considering about half of US families have zero retirement account savings.
Here's how much Americans at every age have in their savings accounts | CNBC.com

Decades of wage stagnation and in some instances downward pressure have resulted in MOST Americans not being able to accumulate any significant savings. People are out here struggling to support their families. I mean just look at all the "tax incentives" around retirement savings .... i.e. 401K and IRA plans ... and despite that HALF of all Americans have none whatsoever. That's the reality on the ground that has to be taken into consideration.

OAW
     
Snow-i
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Mar 1, 2017, 06:11 PM
 
Originally Posted by OAW View Post




And now this is a bridge too far. This is one of those things that sounds good in theory but in practice it simply isn't realistic. For one very simple reason ...



Here's how much Americans at every age have in their savings accounts | CNBC.com

Decades of wage stagnation and in some instances downward pressure have resulted in MOST Americans not being able to accumulate any significant savings. People are out here struggling to support their families. I mean just look at all the "tax incentives" around retirement savings .... i.e. 401K and IRA plans ... and despite that HALF of all Americans have none whatsoever. That's the reality on the ground that has to be taken into consideration.

OAW
I'd certainly be willing to cede that bullet point if it netted those above it. My aim there is really to find a way to connect the end-user with the cost of care, however we accomplish that (without leaving anyone behind).
     
Snow-i
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Mar 1, 2017, 06:22 PM
 
Perhaps we could make the individual mandate apply to savings in an HSA account, instead of having to buy a plan altogether? Instead of paying Uncle Sam a "tax" for not carrying an appropriate level of insurance, we instead force those people to pay themselves? My ideological objections to the mandate would largely be assuaged at that point, because those individuals wouldn't be forced to buy things they don't need - they would only be forced to carry a safety net of tax free money to be used for medical expenses of themselves or their dependents. Not sure how much I love this idea, but hey...brainstorming!


Edited to Add: Also, allow a penalty free transfer of funds from IRAs to HSAs. Maybe even extend that to 401ks (limited to once or twice a year each way). That way, you don't have people being taxed and penalized for utilizing retirement money for healthcare expenditures.
     
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Mar 1, 2017, 06:32 PM
 
^^^

I like the "brainstorming". Always good to exchange ideas! IMO a mandated HSA vs a mandated health insurance plan falls into "a distinction without a difference" category. But more importantly that only goes so far. The healthcare costs that a typical HSA could cover will depleted in short order with a hospitalization or any sort of disease care. So even with an HSA people will still need insurance. So why not simplify the process and just have insurance for everything? The types of expenses that an HSA could realistically cover are what deductibles are for it seems.

OAW
     
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Mar 2, 2017, 08:49 AM
 
Originally Posted by Snow-i View Post
Subsidies don't reduce costs. They only change who is paying.
Yes, that was my point.
I have plenty of more important things to do, if only I could bring myself to do them....
     
The Final Dakar
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Mar 2, 2017, 12:16 PM
 
Some weird shit going on with the repeal bill in the house. Rand Paul using it for some grandstanding
     
Paco500
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Mar 2, 2017, 12:56 PM
 
Originally Posted by Snow-i View Post
I'd certainly be willing to cede that bullet point if it netted those above it. My aim there is really to find a way to connect the end-user with the cost of care, however we accomplish that (without leaving anyone behind).
An issue to consider here. Part of the reason cost per capita (and cost per outcome if that is the proper phrase) in the US is so much higher than in countries with single-payer systems is the ability of those countries to negotiate prices on behalf of the population as a whole. This is a much stronger bargaining position than hundreds of millions individuals negotiating on their own. Basic economic principles would lead one to believe this would likely lead to increased costs.
     
Snow-i
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Mar 2, 2017, 04:11 PM
 
Originally Posted by OAW View Post
^^^

I like the "brainstorming". Always good to exchange ideas! IMO a mandated HSA vs a mandated health insurance plan falls into "a distinction without a difference" category. But more importantly that only goes so far. The healthcare costs that a typical HSA could cover will depleted in short order with a hospitalization or any sort of disease care. So even with an HSA people will still need insurance. So why not simplify the process and just have insurance for everything? The types of expenses that an HSA could realistically cover are what deductibles are for it seems.

OAW
The major distinction is, if they don't use the HSA money, they get to keep it. WIth a health plan, they lose the money regardless of if they use the care or not. I'd say the difference there is more than nominal.

The idea here is that they would still have an insurance plan - the HSA would cover the basics not provided for under insurance (like a routine check up), where the scenario you outline (hospitalization), would. Definitely not arguing that HSA's replace health insurance - I just think they are underutilized for the "short end" of the market. Think of all the money that goes into the insurance administration of routine care, which would likely be much cheaper for the doctors, insurance companies, and end-users without having to go through insurance.
     
Snow-i
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Mar 2, 2017, 04:13 PM
 
Originally Posted by Paco500 View Post
An issue to consider here. Part of the reason cost per capita (and cost per outcome if that is the proper phrase) in the US is so much higher than in countries with single-payer systems is the ability of those countries to negotiate prices on behalf of the population as a whole. This is a much stronger bargaining position than hundreds of millions individuals negotiating on their own. Basic economic principles would lead one to believe this would likely lead to increased costs.
Why wouldn't we allow the end-users to negogiate prices on behalf of themselves? This implies the government is good at negotiating things like price. They are not (see: military spending). Competition here could do wonders without having to spend all that money on lawyers, court cases, administration, actuaries, etc.
     
Snow-i
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Mar 2, 2017, 04:17 PM
 
Originally Posted by Waragainstsleep View Post
Yes, that was my point.
Umm, you said:

"How can a government program reduce staffing costs without huge subsidies? The GOP isn't going to stand for that."

They can't reduce staffing costs "with huge subsidies" either, because subsidies don't reduce costs. There's literally nothing the GOP could not stand for.
     
Snow-i
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Mar 2, 2017, 04:19 PM
 
Originally Posted by OAW

So why not simplify the process and just have insurance for everything? The types of expenses that an HSA could realistically cover are what deductibles are for it seems.

OAW
Forgot to address this:

Because that process is extremely expensive.
     
Paco500
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Mar 2, 2017, 04:41 PM
 
Originally Posted by Snow-i View Post
Why wouldn't we allow the end-users to negogiate prices on behalf of themselves? This implies the government is good at negotiating things like price. They are not (see: military spending). Competition here could do wonders without having to spend all that money on lawyers, court cases, administration, actuaries, etc.
In the UK, there is a body called N.I.C.E. - the National Institute for Clinical Excellence. There primary role is to investigate the efficacy of various dugs and treatments and weigh them against their costs. If a drug is found to be either ineffective, or too expensive for it's benefit, it can pull it from the list of NHS approved treatments.

There have been a number of cases recently where effective drugs have been pulled from availability because the benefit they provided was not significant compared to the cost. Very often, the manufacturer has turned around and offered to drop the price to an acceptable level. If they drop the price enough, the drug is again available. That is the kind of bargaining power an individual would not be able to compete with.

Or what about situations where there is little to no competition- such as rural communities without access to a large enough market to ensure healthy competition. A universal system, or even a larger insurance group, could ensue that individual providers do not abuse their market position at the expense of individuals. The only way to prevent this in your scenario is government regulated pricing, If the goal is 'to get the government out of healthcare,' this is contrast to principles.

I know that reasonable people can argue philosophically about the role government should play in healthcare, but if the prime objectives are reducing costs and maximising outcomes for society, real-world evidence is pretty clear- universal coverage, single payer is the best choice.
     
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Mar 2, 2017, 05:26 PM
 
Originally Posted by Snow-i View Post
The major distinction is, if they don't use the HSA money, they get to keep it. WIth a health plan, they lose the money regardless of if they use the care or not. I'd say the difference there is more than nominal.

The idea here is that they would still have an insurance plan - the HSA would cover the basics not provided for under insurance (like a routine check up), where the scenario you outline (hospitalization), would. Definitely not arguing that HSA's replace health insurance - I just think they are underutilized for the "short end" of the market. Think of all the money that goes into the insurance administration of routine care, which would likely be much cheaper for the doctors, insurance companies, and end-users without having to go through insurance.
Ok. I see where you are coming from. Not a bad idea.

OAW
     
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Mar 2, 2017, 05:31 PM
 
Originally Posted by Snow-i View Post
Why wouldn't we allow the end-users to negogiate prices on behalf of themselves? This implies the government is good at negotiating things like price. They are not (see: military spending). Competition here could do wonders without having to spend all that money on lawyers, court cases, administration, actuaries, etc.
It's basic economics. If you go to the car dealer to negotiate for a good price on a brand new car that's one thing. But if a company that provides car service goes to that same dealer to negotiate for a good price on a FLEET of brand new cars ... well guess who is getting the better deal? One of the main benefits of a single-payer system is the ability to negotiate for volume discounts that individuals simply can't do on their own.

OAW
     
Snow-i
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Mar 2, 2017, 05:31 PM
 
Originally Posted by Paco500 View Post
In the UK, there is a body called N.I.C.E. - the National Institute for Clinical Excellence. There primary role is to investigate the efficacy of various dugs and treatments and weigh them against their costs. If a drug is found to be either ineffective, or too expensive for it's benefit, it can pull it from the list of NHS approved treatments.

There have been a number of cases recently where effective drugs have been pulled from availability because the benefit they provided was not significant compared to the cost. Very often, the manufacturer has turned around and offered to drop the price to an acceptable level. If they drop the price enough, the drug is again available. That is the kind of bargaining power an individual would not be able to compete with.
Uh, if it was too expensive and not effective, instead of a government agency patting themselves on the back for spending millions to come to that same conclusion, people just wouldn't buy that drug. The drug company would either pull it from the market or make it less expensive. You don't need centralized bargaining power when the market itself is setting the prices (which is NOT what's happening today since it all goes through the super expensive insurance process). You spend a whole lot of money for that bargaining power, too. Money that could otherwise be spent on care. Don't even get me started on what kind of lobbying we'd be dealing with in that environment.

Or what about situations where there is little to no competition- such as rural communities without access to a large enough market to ensure healthy competition. A universal system, or even a larger insurance group, could ensue that individual providers do not abuse their market position at the expense of individuals. The only way to prevent this in your scenario is government regulated pricing, If the goal is 'to get the government out of healthcare,' this is contrast to principles.
See my point about selling across state lines. It's not about getting government out of healthcare, it's about reducing the absolute cost of care, a significant portion of which is already attributed to the involvement of the government in the form of an out-dated model and onerous, state level regulations to degrees which aren't necessary where more efficient alternatives are technologically available.

I know that reasonable people can argue philosophically about the role government should play in healthcare, but if the prime objectives are reducing costs and maximising outcomes for society, real-world evidence is pretty clear- universal coverage, single payer is the best choice.
I disagree with your opinion that single payer is the best choice. I believe the system we have today is hampered by out-of-date regulation/law & modernizing the way things work to account for the technological boom would save an unbelievable amount of money, making the care cheaper and more efficient. Do you even have any idea how expensive it is to do business with the government as a contractor and/or supplier? How long it takes? How when it's broken there's almost no hope for effective change? The biggest problem with single-payer is that if it doesn't work off the bat, it never will. Even if it does, a slow decline in efficiency/cost-savings would be impossible to counteract without upending the system.
     
The Final Dakar
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Mar 2, 2017, 05:39 PM
 
Originally Posted by OAW View Post
Ok. I see where you are coming from. Not a bad idea.

OAW
I'll chime in with a nod that it sounds promising.
     
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Mar 2, 2017, 05:46 PM
 
Originally Posted by OAW View Post
It's basic economics. If you go to the car dealer to negotiate for a good price on a brand new car that's one thing. But if a company that provides car service goes to that same dealer to negotiate for a good price on a FLEET of brand new cars ... well guess who is getting the better deal? One of the main benefits of a single-payer system is the ability to negotiate for volume discounts that individuals simply can't do on their own.

OAW
This only applies to physical goods with economies of scale. Healthcare, by definition, is largely driven by service - doctors, nurses, EMTs, etc etc.

This might net some benefit for buying medical supplies, monitors, drugs (that don't expire), vents, pumps, MRIs, xrays, etc en banc, but still wouldn't negate the tip of the iceberg when it comes to medical expenses. The ACA, by contrast, made all those things you're talking about more expensive with the 3% excise tax (which, ironically enough, is used to cover the service side of the industry). If we want to reduce absolute costs, single payer has significant downsides compared to the points I raised above.

BTW, I greatly appreciate the course this discussion has taken
     
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Mar 2, 2017, 05:58 PM
 
To add OAW:

The fleet of cars analogy breaks down when we consider that the dealer would have to bargain for all the cars we will sell this year. Sure they give volume discounts, but when the prospect of that volume being their only revenue for the year under single payer, they consider the fact that no individual sales will be coming in and selling larger volumes at deep discounts makes less sense after considering they will not do any other business.

If Ford expects to sell X amount off cars this year, for X amount of revenue, they have incentive to discount fleet sales as it gets them much closer to their goals and economies of scale allows for it. When you turn that around to say "Ford, you will ONLY sell X amount of cars this year to us" Ford has to think much longer and harder about their revenue goal, as they've got one shot to get it right. In other words, the volume discount dissipates in proportion to the opportunity cost of the higher margins being given up, where the revenue goal is the same.
     
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Mar 2, 2017, 06:12 PM
 
^^^

I guess what I'm saying is that it's about this ...

MARKET POWER .... refers to a company's relative ability to manipulate the price of an item in the marketplace by manipulating the level of supply, demand or both. A company with substantial market power has the ability to manipulate market price and thereby control its profit margin, and possibly the ability to increase obstacles to potential new entrants into the market. Firms that have market power are often described as "price makers" because they have the ability to establish or adjust the marketplace price of an item without relinquishing market share.
Market Power Definition | Investopedia

As it stands now when it comes to pricing .... even for the "service" aspect of healthcare ... the hospital is the "800 LB gorilla" relative to the individual consumer. But in a single-payer system the federal government (or potentially a non-profit "quasi-governmental" public agency if there are ideological objections to direct federal involvement) is the "800 LB gorilla" relative to the hospital. Or the pharmaceutical manufacturer. I've said it before and I'll say it again. Healthcare cost inflation is out of control because the providers CAN. They are the 800 LB gorilla in the game because healthcare is simply NOT an "elastic" market. Nobody who is being rushed to the hospital because of a car accident or chest pains is going to "shop around" on price. We aren't talking about do I purchase the same shirt from Walmart or Target or Amazon here. When a kid is sick with a high fever that parent isn't thinking about asking the doctor what they are charging for the office visit. It just doesn't work that way! Healthcare costs can be brought under control in relatively short order with a single-payer system. Again, as Paco500 has indicated there are real-world examples proving .... not speculating ... this to be the case.

OAW
     
Snow-i
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Mar 2, 2017, 06:20 PM
 
Originally Posted by OAW View Post
^^^

I guess what I'm saying is that it's about this ...



Market Power Definition | Investopedia

As it stands now when it comes to pricing .... even for the "service" aspect of healthcare ... the hospital is the "800 LB gorilla" relative to the individual consumer. But in a single-payer system the federal government (or potentially a non-profit "quasi-governmental" public agency if there are ideological objections to direct federal involvement) is the "800 LB gorilla" relative to the hospital. Or the pharmaceutical manufacturer. I've said it before and I'll say it again. Healthcare cost inflation is out of control because the providers CAN. They are the 800 LB gorilla in the game because healthcare is simply NOT an "elastic" market. Nobody who is being rushed to the hospital because of a car accident or chest pains is going to "shop around" on price. We aren't talking about do I purchase the same shirt from Walmart or Target or Amazon here. When a kid is sick with a high fever that parent isn't thinking about asking the doctor what they are charging for the office visit. It just doesn't work that way! Healthcare costs can be brought under control in relatively short order with a single-payer system. Again, as Paco500 has indicated there are real-world examples proving .... not speculating ... this to be the case.

OAW
That may be true for large hospitals, but that fails to consider the vast amount of private practice doctors and specialists running small outfits, which is how everything outside of a hospital generally works. At that point, they would live or die by the whim of the government, and the incentive to even have a practice would be dictated by someone other than the doctor/practitioner. Doctor's wouldn't be able to make it on their own, and would all work for large medical warehouses (for lack of a better term).

As such, every health outfit would start to look like a big hospital where it only makes sense if they are big enough to survive on the government's chosen rate. This is not desirable in the least, as instead of a choice of 50 doctors running their own practices how they see fit, you would see the big companies open up their "health walmarts" that the little guys these days just can't compete with. You would have a doctor that has no financial incentive to be better then the guy in the room across the hall, and we'd see a quick race to the lowest common denominator. Quality of care would go down, as the doctors have no incentive to provide care above the minimum as they are no longer competing with other doctors - they're just showing up and collecting a check. Even worse, the only way to make more would be to go for higher volume, meaning less time with each patient, and an incentive to clear cases as quickly as possible. Going to the doctor would be like calling comcast technical support.


I don't think paying the doctors/small practices less is the answer here, when there is so much lower hanging fruit out there.
     
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Mar 3, 2017, 10:44 AM
 
Originally Posted by Snow-i View Post
Uh, if it was too expensive and not effective, instead of a government agency patting themselves on the back for spending millions to come to that same conclusion, people just wouldn't buy that drug.
Are you saying that the general public will read and understand medical research papers? That people have a good sense of effective drugs? In a world where the most reliably effective drug is a placebo and people pay $4 for a bottle of tap water because it's well-marketed?
     
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Mar 3, 2017, 07:08 PM
 


I love the pretzels politicians twist themselves into trying to justify revoking coverage on millions of Americans.
     
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Mar 3, 2017, 07:12 PM
 
Originally Posted by Laminar View Post
In a world where the most reliably effective drug is a placebo and people pay $4 for a bottle of tap water because it's well-marketed?
Also, in a world where pharmaceutical companies advertise their drugs on tv, even though the general populace isn't qualified to know the pros and cons of the drug, let alone whether they need it.
     
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Mar 7, 2017, 10:00 AM
 
It's out.
     
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Mar 7, 2017, 11:16 AM
 
And proud!
     
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Mar 7, 2017, 01:15 PM
 
So, it requires people with pre-existing conditions are covered but simultaneously does not require people to have health insurance. It also does a universal flat tax credit instead of one based on regional poverty levels.

Did I miss something regarding those two points?
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Mar 7, 2017, 01:21 PM
 
Gov LePage thinks the GOP plan sucks too.

?
     
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Mar 7, 2017, 01:24 PM
 
It's not regressive enough for the right and makes healthcare shittier to the left. It's like the opposite of a good compromise.
     
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Mar 7, 2017, 02:34 PM
 
What a surprise. The poor and elderly get stuck with higher costs. And removing the tax penalty for not carrying insurance means the individual mandate has no teeth. So ... insurance death spiral coming. Fewer people sign up, prices go up, fewer people sign up, etc. Effectively a repeal that takes 5-10 years to run its' course, with steadily higher prices for those least able to pay.
     
The Final Dakar
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Mar 7, 2017, 03:51 PM
 
Don't forget the amazing tax cuts for the rich, including tax break for insurance execs making $500k, and removal of the mandate that insurance companies devote 80% of their premiums to medical claims.

These people are narrow minded and shameless.
     
The Final Dakar
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Mar 7, 2017, 04:05 PM
 
I'm really curious as to how this goes. Hardline conservatives say since it still has government benefits it's a no go. Moderate republicans either oppose rolling back Medicaid or defunding planned parenthood.
     
The Final Dakar
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Mar 7, 2017, 06:27 PM
 
So here's the best part, as far as politics are concerned: The GOP wants to ram this through without hearings or CBO scoring (which I'm sure is atrocious. No way this is 'fiscally responsible'). If you were angry at the ACA being shoved down our throats after over a year, you must be incensed and outraged at what the GOP is trying to do here.
     
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Mar 7, 2017, 09:29 PM
 
Originally Posted by The Final Dakar View Post
So here's the best part, as far as politics are concerned: The GOP wants to ram this through without hearings or CBO scoring (which I'm sure is atrocious. No way this is 'fiscally responsible'). If you were angry at the ACA being shoved down our throats after over a year, you must be incensed and outraged at what the GOP is trying to do here.
That strikes me as another unforced error in the making.
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The Final Dakar
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Mar 8, 2017, 12:33 AM
 
Originally Posted by OreoCookie View Post
That strikes me as another unforced error in the making.
Quite the opposite. Time allows for response. Less time easier to put through.

Theoretically. Unfortunately a ton of conservative groups already came out against the plan.
     
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Mar 8, 2017, 12:52 AM
 
Trump warns House GOP members of electoral 'bloodbath' if repeal and replace fails - CNNPolitics.com

Now thats a conundrum. They can either thwart Trump or thwart conservative groups and their constituents. And I have no guesses as to which group the GOP will side with.
     
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Mar 8, 2017, 01:02 AM
 
     
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Mar 8, 2017, 01:18 AM
 
Originally Posted by The Final Dakar View Post
Quite the opposite. Time allows for response. Less time easier to put through.

Theoretically. Unfortunately a ton of conservative groups already came out against the plan.
Health care, as President Trump says™, is difficult, and rushing a law through without proper vetting and discussion is quite dangerous. Conservatives like Rand Paul oppose it, because Trump Care is just Obama Care Light while Democrats oppose it, because it doesn't improve in the areas where the ACA needs improving (a fallback insurance option available to anyone, a focus on lowering prices, etc.). So the GOP risks of not being able to pass the law, the Democrats just need three GOP senators to break ranks and vote against it. It surely doesn't help that some people within the GOP were purposefully kept out of the deliberation process.

Honestly, it seems to me that the Republican party didn't want to touch most of the main points of the ACA: apart from getting rid of the individual mandate, they kept the pre-existing conditions clause and allowed college students to be enrolled in their parents's — things opponents would call “creating an entitlement”. On the other hand, because it doesn't address a reduction of health care cost (the ACA was mostly about expanding coverage), I don't see support from ACA proponents either. It seems like a middling bill that doesn't want to take a stance either way and just do minimal work at the edges. Pushing this bill through reminds me of the first travel ban executive order: shoddily conceptualized, shoddily realized and shoddily implemented.

So even if it is passed, to me the law seems to make the situation worse: it will reduce coverage (e. g. by abolishing the individual mandate), tax credits won't do anything to people who don't pay taxes in the first place (many of whom were able to get health insurance for the first time) and as I said, it does nothing to reduce costs. If that is the case, then voters will be unhappy, because this is now all on the GOP.
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The Final Dakar
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Mar 8, 2017, 09:28 AM
 
Right. They got rid of everything they hated, half assed some measures and called it a day.

I've also read this introduces caps on Medicaid that didn't exist pre ACA and makes Medicare more insolvent. If this passes it'll be a real outrage.
     
The Final Dakar
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Mar 8, 2017, 09:45 AM
 
"Insurance is not really the end goal here"

This is some fantastic salesmanship
     
The Final Dakar
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Mar 9, 2017, 12:01 AM
 
So, the predicted outcome now is the bill somehow passes the house but dies in the senate. Some claim this is to give Rs cover while pinning the blame on Ds. What makes no sense is they created a bill no one likes. I mean, why not go down with the straight repeal if its not going to pass?
     
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Mar 9, 2017, 12:27 AM
 
I don't suffer from insanity, I enjoy every minute of it.
     
The Final Dakar
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Mar 9, 2017, 09:37 AM
 
Everything I've seen says that's a different bill.
     
Laminar
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Mar 9, 2017, 04:34 PM
 
Originally Posted by Cap'n Tightpants View Post
Of course they didn't have a plan, but then you don't need to have something ready to go (because such a thing would be seriously expensive and would require an appropriation bill, which we know Obama or Hillary wouldn't sign off on), just to realize that what you currently have now is shit.
So with the plan's details released, where was the appropriation bill created to fund the design of this new plan?
     
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Mar 9, 2017, 06:17 PM
 
Sure, I plan on spending the next 2-3 days digging through every appropriations bill they've passed over the last several months looking for it. I'll get right on that.
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Mar 9, 2017, 08:39 PM
 
Originally Posted by The Final Dakar View Post
Everything I've seen says that's a different bill.
Yeah, that seemed to good to be true, I should have been more skeptical. It turns out it is a competing alternative to the AHCA aka TrumpCare from Pete Sessions. Was worth a laugh nonetheless.
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Mar 9, 2017, 10:44 PM
 
     
 
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