Author Topic: The ACA/Obamacare Thread  (Read 14668 times)

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Offline lonestar

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The ACA/Obamacare Thread
« on: January 14, 2017, 04:28:51 PM »
OK, I'm not gonna lie, I don't know a whole bunch about all the little details surrounding this whole thing, which is the main reason I'm making the thread. I want to hear all viewpoints on this. My main circles, being in the SF Bay Area, are obviously a very liberal echo chamber, and my knowledge of health care in general is limited since I've had excellent union coverage for over a decade and haven't had to wonder or worry.


So...discuss the whole thing in general, and I'd love to hear some arguments from the conservative side as to why "taking healthcare away from millions" is/will be good for the country as a whole.
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Offline eric42434224

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Re: The ACA/Obamacare Thread
« Reply #1 on: January 14, 2017, 04:32:14 PM »
One opinion i want to throw out there is this:
Repealing the ACA without a replacement is, for lack of a better word, stupid.
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Offline Adami

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Re: The ACA/Obamacare Thread
« Reply #2 on: January 14, 2017, 04:49:28 PM »
As a therapist, almost all of my clients/patients pay through Medical (which is the california obamacare thing). If they all lose it, they're all screwed and I'm basically out of a job.


Luckily, I'm very certain that a full repeal is unlikely.
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Offline 7th

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Re: The ACA/Obamacare Thread
« Reply #3 on: January 14, 2017, 05:01:45 PM »
I'm for universal free healthcare for all.  ACA was a scam marketplace that forced people to pay private companies under the penalty of tax extortion (in other words if you didn't participate, you get a bill from the IRS for not participating).  That alone disqualifies it from being a good (or even legal) program in my opinion.  Good programs do not twist arms to get participants.  If they repeal and replace, they need to replace with a system that provides equal access to healthcare to all people, citizens, non-citizens, rich, poor, old, young.  Otherwise it isn't good enough in my opinion and should be repealed as well.  I we can dump trillions into machines of destruction, we can dump trillions into high quality healthcare for all. 

If Stadler is around he'll probably tell me I'm being unrealistic, but I challenge that notion.  We educate every child in the USA, we can take care of our sick as well, and we can do it with the most sophisticated medical research and quality of care.  Of course we'd have to completely revamp the inefficient and stupidly costly/wasteful systems that are in place now.  A simple doctor office visit should be done by house call like back in my parent's time.  Technology and wearables should be better employed to effectively monitor people with serious chronic conditions.  Doctors should run clinical services, not the MBAs (you can thank HRC for that "managed care" bullshit).  Basically we'd have to step backward to leap forward because the "progress" in clinical care delivery has been going down the wrong path entirely.     
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Offline KevShmev

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Re: The ACA/Obamacare Thread
« Reply #4 on: January 14, 2017, 05:52:23 PM »
My two general thoughts are:

1) the ACA has been a train wreck.

2) the GOP is so desperate to get rid of it, that they'll come up with something half-assed just so they can say they replaced it.


Offline eric42434224

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Re: The ACA/Obamacare Thread
« Reply #5 on: January 14, 2017, 06:31:07 PM »
My two general thoughts are:

1) the ACA has been a train wreck.

2) the GOP is so desperate to get rid of it, that they'll come up with something half-assed just so they can say they replaced it.

I think the GOP is scared shitless because they have to come up with something that is MUCH better, and demonstrably so.  Repealing it is a hollow victory if they can't replace it with something better, and they are scared that their version might not work out so great.  Thus the lame action of repealing it but still keeping it.
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Re: The ACA/Obamacare Thread
« Reply #6 on: January 14, 2017, 07:47:08 PM »
How about better it?  It blows my mind with what medical costs the middle class.  I'd rather suffer than pay money for doctors to guess.  Sad to say.
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Offline eric42434224

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Re: The ACA/Obamacare Thread
« Reply #7 on: January 14, 2017, 07:48:32 PM »
My two general thoughts are:

1) the ACA has been a train wreck.

2) the GOP is so desperate to get rid of it, that they'll come up with something half-assed just so they can say they replaced it.

I think the GOP is scared shitless because they have to come up with something that is MUCH better, and demonstrably so.  Repealing it is a hollow victory if they can't replace it with something better, and they are scared that their version might not work out so great.  Thus the lame action of repealing it but still keeping it.
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Offline Chino

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Re: The ACA/Obamacare Thread
« Reply #8 on: January 16, 2017, 05:44:15 AM »
The ACA is on the right track. It's got some pretty serious flaws that were not originally anticipated to be as big of a deal as they've ended up being. There are things within the ACA in much need of an overhaul. The ACA has also done a lot of good and allowed people that would otherwise not be able to seek medical treatment end up living semi-normal lives.

The ACA needs work. Outright repealing it is fucking stupid. Fix the damn thing. The majority of the GOP has had almost 7 years now to come up with solutions like they're paid to do, and all they've done instead is bitch.

Sign me up for single payer. I hate the fact that one of the main reasons I stay working a job I hate is because of the health coverage I receive. I don't think people should be apprehensive to start their own businesses due to the lack of an affordable health plan.

Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #9 on: January 16, 2017, 08:42:21 AM »
OK, I'm not gonna lie, I don't know a whole bunch about all the little details surrounding this whole thing, which is the main reason I'm making the thread. I want to hear all viewpoints on this. My main circles, being in the SF Bay Area, are obviously a very liberal echo chamber, and my knowledge of health care in general is limited since I've had excellent union coverage for over a decade and haven't had to wonder or worry.


So...discuss the whole thing in general, and I'd love to hear some arguments from the conservative side as to why "taking healthcare away from millions" is/will be good for the country as a whole.
ACA in a nutshell: The law requires every person to have have health insurance. Most get it through their workplace while some have to shell out on their own. People making less than 4x the Federal Poverty Level, currently around $44k or so, will receive a subsidy in the way of tax credits. People making under FPL are directed to Medicaid which was expanded in many states to accommodate them. So the government pays for the poor and by forcing everybody into the insurance pool the insurance companies are able to cover the sick.

The basic downside of this is that the insurance companies found out that having to insure sick people is expensive. Some of us already knew that. To use the Stadler analogy, it's like being able to sign up for homeowner's insurance after your house burned to the ground. In response to the high costs the insurance companies tightened up pretty much across the board. Everybody's premium went up and the quality of everybody's coverage went down. Moreover, everything consolidated. Now instead of seeing the doctor of your choice, the insurers all started working within networks. Your doctor might or might not be part of their network, and if he's not you're SOL--find a new one.

Most of the liberals (and a handful of libertarian republicans) are bent out of shape because most of us wanted single payer, like what you've heard about up in Canada. Essentially it'd be like expanding medicare to cover everyone in America. This whole thing just seemed like a big Christmas gift to the insurance companies who are now sticking it to us.

The other side of the spectrum is pissed off anytime the government forces them to do something, which I can certainly understand. Damn near everybody's pissed off that their premiums went up. There's also a pretty high amount of "Obama=evil so it must be awful" and "republicans hate the thing so it must be pretty good" stupidity going around.

Grabby's plan is to find a way to rid us of the mandate (the part that requires everybody to have insurance) while keeping the most number of people insured. This is honestly not likely to happen. Being sick in this country is stupidly expensive and nobody wants to pay the costs. The (republicans) don't want to pull the carpet out immediately because something like 20 million have insurance via an ACA plan. Under normal circumstances I'd be one and it'd be crippling to me. The trick is finding a way to let the healthy 75% do what they want with insurance while seeing to it that the sick and poor among us can receive affordable healthcare. Personally, my take is that ain't gonna happen. The only way to take care of people like me is to make sure everybody kicks into the pool.

My hunch is that we essentially go back to basically where we were before. Buy insurance if you want. Don't if you don't. There will be some nice programs to help the average folk who can afford to take advantage of them but most won't. The sick will be relegated to sick pools where they pay 4x as much for the worst possible coverage. The poor will be at the mercy of the governor of the state they live in. Californians will do alright. Texans won't. Our president will pronounce it wonderful and tout it as the finest system in the world.
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Offline mikeyd23

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Re: The ACA/Obamacare Thread
« Reply #10 on: January 16, 2017, 10:18:59 AM »
Good post Barto^

Just saw this article and wanted to get some people's thoughts:

https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?utm_term=.ef935b54614e

Basically, Trump saying that insurance will "still be available for everybody" but still says he will drive costs down... Not sure this means anything because it kinda misses the mark. Insurance has always been available to all, a lot were just not able to afford it before the ACA.

Offline lonestar

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Re: The ACA/Obamacare Thread
« Reply #11 on: January 16, 2017, 10:32:01 AM »
Beast level post Barto, that's exactly the type of info I wanted.
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Offline jsbru

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Re: The ACA/Obamacare Thread
« Reply #12 on: January 16, 2017, 12:49:05 PM »
Basically, Trump saying that insurance will "still be available for everybody" but still says he will drive costs down... Not sure this means anything because it kinda misses the mark. Insurance has always been available to all, a lot were just not able to afford it before the ACA.

Everybody wants that.  That's what Obamacare was trying to achieve.

The best way is still single payer.  If Donald Trump has to go full socialist on us to get that done, I'm perfectly fine with that.

I'm on Obamacare right now, though, so if Republicans repeal without replacing, I will be without health insurance.
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Offline Tick

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Re: The ACA/Obamacare Thread
« Reply #13 on: January 16, 2017, 12:52:14 PM »
ACA is a form of oppression designed to soak every disposable sent out of every American to give them total shit health care with high premiums and deductibles so poor people can have great coverage for free on the backs of the sucker middle class who are over paying.

As for paying a fine for not having it. A fine that increases every year you don't. Total bullshit.


"You can't be turned down for a pre existing condition"
No you can't, but just as a person trying to get life insurance with a prior condition of cancer or whatever ailment, they will price you through the roof. So can you get the health insurance? Yes. Can you afford what they will want to extract from you for it? Most likely not.

Fix it? No way. It will be replaced and not fixed, because ya can't fix stupid.

This post will get lambasted but I don't care.
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Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #14 on: January 16, 2017, 01:18:20 PM »
"You can't be turned down for a pre existing condition"
No you can't, but just as a person trying to get life insurance with a prior condition of cancer or whatever ailment, they will price you through the roof. So can you get the health insurance? Yes. Can you afford what they will want to extract from you for it? Most likely not.
Actually, under ACA they couldn't charge you any more than anybody else, so they just raised the rates on everybody else slightly to offset it. After ACA they will be able to charge you more, so everybody else will see their rates go down slightly, and the sick will see theirs go through the roof. Been down that road already. The average bloke will go back to buying really crappy policies for cheap, and people with a history of kidney disease or breast cancer will pay four times as much for even shittier policies.
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Offline jsbru

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Re: The ACA/Obamacare Thread
« Reply #15 on: January 16, 2017, 11:17:24 PM »
Besides that, Obamacare is funded by a tax on the wealthy, not a tax on the middle-class.
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Offline mikeyd23

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Re: The ACA/Obamacare Thread
« Reply #16 on: January 17, 2017, 07:34:26 AM »
Besides that, Obamacare is funded by a tax on the wealthy, not a tax on the middle-class.

It sounds good to say, but as a middle class working man, I can tell you I'm certainly helping to fund it  :lol

Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #17 on: January 17, 2017, 08:09:07 AM »
Everybody's taxed and everybody funds it. We're also taxed to fund the people who show up at the public hospital when they get the flu or drive their Escalade into a ditch. That's the reason I never had a problem with fining the uninsured.
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Offline mikeyd23

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Re: The ACA/Obamacare Thread
« Reply #18 on: January 17, 2017, 08:12:25 AM »
Everybody's taxed and everybody funds it. We're also taxed to fund the people who show up at the public hospital when they get the flu or drive their Escalade into a ditch.

Absolutely, I just stated the obvious because jsbru's comment made it seem like unless you and I fell into some high tax bracket, we weren't funding the ACA in anyway.

Offline Tick

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Re: The ACA/Obamacare Thread
« Reply #19 on: January 17, 2017, 08:47:36 AM »
"You can't be turned down for a pre existing condition"
No you can't, but just as a person trying to get life insurance with a prior condition of cancer or whatever ailment, they will price you through the roof. So can you get the health insurance? Yes. Can you afford what they will want to extract from you for it? Most likely not.
Actually, under ACA they couldn't charge you any more than anybody else, so they just raised the rates on everybody else slightly to offset it.

"Slightly"

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Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #20 on: January 17, 2017, 09:42:22 AM »
"You can't be turned down for a pre existing condition"
No you can't, but just as a person trying to get life insurance with a prior condition of cancer or whatever ailment, they will price you through the roof. So can you get the health insurance? Yes. Can you afford what they will want to extract from you for it? Most likely not.
Actually, under ACA they couldn't charge you any more than anybody else, so they just raised the rates on everybody else slightly to offset it.

"Slightly"

Where is a cymbal when you need one! :lol
I used slightly quite deliberately, as it's correct in this relative context. You can either raise the rates on the sick folk 400%, or you can raise the rates on everybody 25%.
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Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #21 on: January 17, 2017, 10:34:17 AM »
Besides that, Obamacare is funded by a tax on the wealthy, not a tax on the middle-class.

Flat wrong.  That's what was sold, but it's not how it worked out.   We're all paying for it in some form or fashion.

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Re: The ACA/Obamacare Thread
« Reply #22 on: January 17, 2017, 12:41:28 PM »
My issue with Obamacare is less about what's in the law...we're never going to get away from getting the shaft from the Healthcare industry and Pharma Co's....just not gonna happen anytime soon. Until we create competition by opening up State lines and even borders as far as being able to shop around we're all being held by the balls and squeezed.

My issue with the law is that 70% of American's at the time Obama was pimping this thing DID NOT WANT it...or anything resembling it. We didn't. Somewhere in this thread or another one I actually took the time out to cite and post a good number of polls at the time and a detailed description of the BS shenanigan moves he utilized to pass this atrocity....He ignored the majority of Americans and when he couldn't get it passed by traditional methods he waited until a recess and used multiple 'legal' yet very shady and low balled moves to get this thing into law, and it was hailed as some massive 'success'.

The law was always doomed to fail not just because Repubs were pi$$ed about it...or that Americans were pi$$ed he did it when they didn't want it....but also because it's a horribly written law that is only going to get worse.
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Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #23 on: January 17, 2017, 03:54:01 PM »
If we're honest about increasing competition, we should get rid of the odd nexus of "employer" and "insurer".  We don't get our electricity as an added benefit from our employer.  We don't get our car insurance as an added benefit from our employer.  Etc., etc.   

And interestingly, that will be yet another way of complaining about this; those premium subsidies paid by corporations are not going to go to the employee in the form of a raise, and we will have to translate (or improve on) any savings earned by negotiations with the insurers by employers (it's also, largely, a healthier pool, since companies are disincented to invest heavily in workers that are not healthy enough to be productive or at least stay on the job).

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Re: The ACA/Obamacare Thread
« Reply #24 on: January 17, 2017, 06:13:45 PM »
Personally, the part I dislike most about Obamacare was the fact it became law for you to have health insurance.  That sounds nice and all, and I get it too, the healthy need to pay for the poor for this to work... but like all things forced, people will always refuse.  Tons of people decided paying the penalty is cheaper than the insurance.  It breaks the system on some levels.  For me, I went uninsured for about 5 years.  I think I paid a full doctor bill once in that period and luckily never got seriously injured.  Saved me probably about 10k at least.  I don't think it's right to force healthy people into the program. 

On the other hand, insuring the sick people who need the coverage the most is a really good thing for ACA.  I know Trump wants to keep this, but it is hard to see how they can keep this while bringing the prices down. I hope Trump and co can find a way, but not sure I see it.

Offline eric42434224

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Re: The ACA/Obamacare Thread
« Reply #25 on: January 17, 2017, 06:23:47 PM »
Trump says everyone will have healthcare...and we will have lower premiums & deductibles.  Not sure how that will happen, when he also wants to build a wall and increase infrastructure spending at a trillion dollars +, lower taxes, increase military spending, and balance the budget.  Something has to give. The deficit will go through the roof.
It is going to be quite a show as the GOP seems to be at odds with increased government and spending.
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Re: The ACA/Obamacare Thread
« Reply #26 on: January 17, 2017, 08:37:48 PM »
It is going to be quite a show as the GOP seems to be at odds with increased government and spending.

According to them, maybe....
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Offline jsbru

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Re: The ACA/Obamacare Thread
« Reply #27 on: January 23, 2017, 02:14:46 PM »
Trump says everyone will have healthcare...and we will have lower premiums & deductibles.  Not sure how that will happen, when he also wants to build a wall and increase infrastructure spending at a trillion dollars +, lower taxes, increase military spending, and balance the budget.  Something has to give. The deficit will go through the roof.
It is going to be quite a show as the GOP seems to be at odds with increased government and spending.

Trump's campaign rhetoric was perhaps more unhinged from the possible than any candidate in our nation's history.

The only way that this country will be able to spend $1 trillion on infrastructure, however many hundreds of billions on building a wall, giving everyone health insurance--all while cutting taxes for the rich--is to run up huge, gigantic deficits.

And running up huge deficits will cause massive inflation, which will raise production costs of US goods.  That's going to be really bad for US exports, and could further erode our manufacturing base.  Punishing companies for moving their jobs overseas will not be enough to combat that--not even close.

His promises have no basis in reality whatsoever, so people are bound to be disappointed.
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Offline DragonAttack

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Re: The ACA/Obamacare Thread
« Reply #28 on: January 23, 2017, 07:08:27 PM »
Here is a side many are probably unaware of

http://www.baltimoresun.com/health/bs-hs-aca-maryland-impact-20170119-story.html

If the law is changed, we will all pay more in taxes to subsidize ER visits that cannot be turned away per law.  We still pay now, but much less than before.  Talk to the experts at Johns Hopkins as to what they think the fall out will be if ACA is overturned.

As to me, I am a bit sorry that a friend and former co-employee of mine, whose wife was treated for cancer about a decade ago, was upset that there was government interference and 'socialism' in regards to health care insurance.  Meanwhile, why am I paying more for his wife to be treated? 

(btw....of course I am frickin' glad his wife was able to have treatments and her cancer is still in remission).

I work for a nonprofit health insurance company.  The ACA has been a pain in the axe, because there are a gazillion fixes, but various special interests refuse to allow the solutions to be put into place.

This edict would have more warmly received, and slightly less contested, had it been named 'Teddy Kennedy Care', dontcha think?

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Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #29 on: January 24, 2017, 07:16:40 AM »
I don't understand all of your post, but two questions:

Why do we assume that ER visits will be the norm, and that the cost will go up?  The ACA will be REPLACED.  I don't know why that is such a hard concept to understand. It will be REPLACED.  They have already pledged to keep "preexisting conditions" and the "mandate", so "millions" aren't all of a sudden going to be out of insurance.   

Okay, one question and one comment:   I am adamantly against the ACA.  I can only speak for me, but as someone that isn't bugged by the notion of "socialized healthcare" (we've had it in one form or another since the mid 60's, and in earnest since the 80's) and who recognizes that despite being a fervent free-market advocate, single-payer is the way to go if we are committed to subsidizing our nations healthcare, I would have been a lot more supportive if:
- they had taken more care in the crafting of the bill, and not rammed it down our throats with a haste that was unseemly (and resulted in a LOT of iterative changes after the fact)
- they had taken more care in lowering the transactional costs across the board; the only way you do that is increase the transparency, and that didn't happen
- Obama didn't prove himself to be a sell-out politician by cutting a massive deal with the pharmaceuticals - $80 BILLION and a guarantee of profits - while throwing the insurers under the bus
- they didn't gut provisions that promoted the single biggest weapon against increased costs, WELLNESS.  The Flex Spending program, for example, was gutted, and only useful when coupled with, surprise surprise, more bureaucracy
- they didn't do dick about the state-by-state regulation, which is probably the single biggest contributor to increased costs
- they did little to break the odd and unwieldly union between employers and insurance.  It makes no sense, and contributes to the increased costs

Name it whatever you want, but do it better.  That it worked, nominally, in ONE STATE for $5 million people is not determinative that it would work in a nation of 52 states and 325 million people.   Wait, that's cards in a deck.  50.  50 states.  Right?

Offline hefdaddy42

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Re: The ACA/Obamacare Thread
« Reply #30 on: January 24, 2017, 07:38:38 AM »
Why do we assume that ER visits will be the norm, and that the cost will go up?  The ACA will be REPLACED.  I don't know why that is such a hard concept to understand. It will be REPLACED.  They have already pledged to keep "preexisting conditions" and the "mandate", so "millions" aren't all of a sudden going to be out of insurance.   
The House and Senate have been pretty clear that they are of the mind to repeal NOW and replace LATER.  They have no plan right now, so anything they say about any potential hypothetical future plan should be taken with a grain of salt.

Of course, Trump claims to have his own plan, but I will believe it when I see it.
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Re: The ACA/Obamacare Thread
« Reply #31 on: January 24, 2017, 07:57:39 AM »
Why do we assume that ER visits will be the norm, and that the cost will go up?  The ACA will be REPLACED.  I don't know why that is such a hard concept to understand. It will be REPLACED.  They have already pledged to keep "preexisting conditions" and the "mandate", so "millions" aren't all of a sudden going to be out of insurance.   
The House and Senate have been pretty clear that they are of the mind to repeal NOW and replace LATER.  They have no plan right now, so anything they say about any potential hypothetical future plan should be taken with a grain of salt.

Of course, Trump claims to have his own plan, but I will believe it when I see it.

But understand what that means.  "REPEAL" doesn't mean the law goes away as if it never existed immediately.  It means, "we have a timetable now; once the replacement plan is put forth and approved, it's a foregone conclusion and we all agree that the existing plan is gone, but in the meantime, it's business as usual unless and until the replacement is put forth". 

Honestly, Hef, you're a smart guy.  You should know this.   Claiming, falsely that "repeal now" means anything more than political grandstanding, and a showing that they mean what they say, is akin to Palin screaming about DEATH PANELS! - wrongly - back in aught eight.  This is partly why I was so critical of the "TERRIFIED!" idea; a lot of it is a result of fear-mongering by the very people claiming to be TERRIFIED!

Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #32 on: January 24, 2017, 08:09:21 AM »
Part of the problem is that we honestly have no idea WTF their plans are. You and a certain piscine poster elsewhere say they've made it abundantly clear they'll be keeping the pre-existing conditions clause and the mandate, but I've seen no such assertion from them.  What I have seen is a congress that has no clue how to get something they really want and a president that couldn't be trusted to tell you the correct time. Moreover, what they have said with regards to repeal and replace is that they'll be removing the teeth from the ACA, and I believe have already taken care of that via executive order. You're also a smart guy. What happens during the interim when people are no longer forced to pay into the system? How does the house of cards stand up when people can remove their card whenever they feel like it?
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Offline hefdaddy42

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Re: The ACA/Obamacare Thread
« Reply #33 on: January 24, 2017, 08:10:18 AM »
You think when they say "Repeal ACA now and replace it later" that they are going to do a conditional repeal?  Typically repeals are either immediate or have a fixed date.  So assume it's the latter.

Assume repeal passes tomorrow, with a fixed date of 3 years hence. 

They still have to come up with a replacement, which will satisfy enough of the politicians to get approved and also work with providers, insurance companies, and pharmaceutical companies to get their input.  That will take a while.  And with that kind of law, it also won't START immediately; it will have a date in the future that it takes effect.  It may even have phased start dates for various functions like the ACA did.  No reason to think the end date of the ACA and the start date of the new law would coincide, under this example.

The better play would be to leave the ACA alone altogether UNTIL the replacement is ready; that way you could have the end of the ACA and the beginning of the replacement coincide.  But that is NOT what they are talking about right now.
Hef is right on all things. Except for when I disagree with him. In which case he's probably still right.

Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #34 on: January 24, 2017, 08:32:13 AM »
Part of the problem is that we honestly have no idea WTF their plans are. You and a certain piscine poster elsewhere say they've made it abundantly clear they'll be keeping the pre-existing conditions clause and the mandate, but I've seen no such assertion from them.  What I have seen is a congress that has no clue how to get something they really want and a president that couldn't be trusted to tell you the correct time. Moreover, what they have said with regards to repeal and replace is that they'll be removing the teeth from the ACA, and I believe have already taken care of that via executive order. You're also a smart guy. What happens during the interim when people are no longer forced to pay into the system? How does the house of cards stand up when people can remove their card whenever they feel like it?

I've heard several say it, including Paul Ryan, but by god, it's fucking impossible to find an article - even in respected journals - that isn't a walking op-ed piece.   I was reading this for example:  http://www.msnbc.com/rachel-maddow-show/paul-ryan-has-message-those-pre-existing-conditions and it turned into a sarcastic jab at all Republicans in about three paragraphs. 

Well, what's going to possibly happen is risk pools, and I know you're not at all in favor of that.  Fair point, it's a problematic approach if done incorrectly, but let's debate THAT, instead of making snide and snarky comments about all Republicans in general, and mischaracterizing everything they've said to boot.   If done right, it could work; what they're saying is, instead of making all people pay for the higher-risk people through premiums, have the states pay for it.  We're all going to pay, ultimately, but the mechanism is important.   And it keeps premiums down, which by extension takes out the transactional costs of anywhere from one to five layers of payments.    Cut right to the chase at let the government fund it, without the overhead.