Author Topic: The ACA/Obamacare Thread  (Read 13979 times)

0 Members and 1 Guest are viewing this topic.

Offline Chino

  • Be excellent to each other.
  • DT.net Veteran
  • ****
  • Posts: 19299
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #595 on: August 01, 2017, 06:18:36 AM »
http://www.ibtimes.com/political-capital/bernie-sanders-drug-price-bill-would-save-billions-congressional-analysts-say

Looking to take advantage of President Donald Trump’s promise to lower drug prices,  Vermont Sen. Bernie Sanders, along with 21 Democratic lawmakers, introduced the Affordable and Safe Prescription Drug Importation Act on Feb. 28. The bill was referred to the Senate’s Committee on Health, Education, Labor, and Pensions.

CBO estimates that the change would in total reduce federal government drug spending by more than $6.8 billion over ten years, including a reduction of $5.1 billion in direct spending and roughly $1.7 billion in increased revenue.

Before introducing the new legislation, Sanders and Democratic Sen. Amy Klobuchar of Minnesota in January introduced a budget amendment allowing Americans to purchase drugs from Canada. In contrast to typical party-line votes, 13 Republicans voted with the Democrats in supporting the amendment, while 13 Democrats joined the remaining Republicans in voting it down. The tally was 52-46 against the amendment.



I don't think something like this would be a bad start.

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #596 on: August 01, 2017, 06:41:54 AM »
Don't disagree, but it can't be done in a vacuum.   

One of the things I would have done as part of the ACA (or any meaningful reform) was do away with the $80 billion profit guarantee to the pharmaceuticals, but I would have provided government subsidies for R&D that couldn't be recouped from sales.   The Gov wouldn't pay to R&D things like Viagra or other drugs that have a ready market, but for those formulations where the R&D is exhorbitant compared to the expected return, I would give the "$80 billion" in the form of R&D subsidies. 

This will, as far as I understand it (there are those here that know far more about this than I do) make the "buy from Canada" a far more attractive proposition for those doing the selling.   I fear that this is not going to result in savings, but rather jack up the prices in Canada. 

Offline Chino

  • Be excellent to each other.
  • DT.net Veteran
  • ****
  • Posts: 19299
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #597 on: August 01, 2017, 07:05:47 AM »
Don't disagree, but it can't be done in a vacuum.   

One of the things I would have done as part of the ACA (or any meaningful reform) was do away with the $80 billion profit guarantee to the pharmaceuticals, but I would have provided government subsidies for R&D that couldn't be recouped from sales.   The Gov wouldn't pay to R&D things like Viagra or other drugs that have a ready market, but for those formulations where the R&D is exhorbitant compared to the expected return, I would give the "$80 billion" in the form of R&D subsidies. 

This will, as far as I understand it (there are those here that know far more about this than I do) make the "buy from Canada" a far more attractive proposition for those doing the selling.   I fear that this is not going to result in savings, but rather jack up the prices in Canada.

But if Canada raised their prices, wouldn't people then just move onto a different country? If Canada wanted to remain competitive in the market place and was okay with maintaining their current level of profitability (which would increase anyway if the US started buying from them), they wouldn't want to give countries like India a competitive edge by pricing themselves out.

Offline jingle.boy

  • DTF's resident deceased dictator
  • DTF.org Alumni
  • ****
  • Posts: 20861
  • Gender: Male
  • The changing of the worrd is inevitabre!!!
Re: The ACA/Obamacare Thread
« Reply #598 on: August 01, 2017, 07:26:12 AM »
As for your numbers, no, not with your math.  But that's not how it works; every minute ISN'T $230.   Some minutes are unbillable.  The paperwork, the administration.  Some minutes are only billable at a fixed, pre-negotiated rate.   When you average out that "$230" out over the total number of seconds for the year, it's absolutely NOT $26.7 M or whatever.

Fair point... but take other service industries, Law for instance which you would be well versed in.  Not every minute/hour of your time is billable (though, that is the goal in many service industries).  What would a client of yours do if you charged $230 for a simple add-on question made by a client at the end of a 10 minute meeting?  I wasn't trying to say that Doctor's actually make $14k/hr, but this fee would equate it to that, which hardly seems fair/reasonable to me.

the don't ask/don't tell isn't normalized by the customers, it's normalized by the system itself (which is an oxymoron, but still).

That's a better way of putting it for sure.
Dream Theater Forums: Expanding musical tastes and shrinking wallets since 2009.
Note to forum, jingle is usually right.
I'm actually disappointed he's not Kim Jong-Il

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #599 on: August 01, 2017, 08:44:10 AM »
As for your numbers, no, not with your math.  But that's not how it works; every minute ISN'T $230.   Some minutes are unbillable.  The paperwork, the administration.  Some minutes are only billable at a fixed, pre-negotiated rate.   When you average out that "$230" out over the total number of seconds for the year, it's absolutely NOT $26.7 M or whatever.

Fair point... but take other service industries, Law for instance which you would be well versed in.  Not every minute/hour of your time is billable (though, that is the goal in many service industries).  What would a client of yours do if you charged $230 for a simple add-on question made by a client at the end of a 10 minute meeting?  I wasn't trying to say that Doctor's actually make $14k/hr, but this fee would equate it to that, which hardly seems fair/reasonable to me.

Well, let's go back to the start here; it is an ethics requirement that when the agreement is entered into to represent someone, the fee schedule is clearly and completely laid out.   So they know.  I can't do anything that they don't know.  If my fee schedule said that - "Any stand alone 10-minute blocks shall be billed at the rate of $23/minute" - then we'd be fine, and as is usually the case in a capitalist transaction, they'd have the opportunity to weigh the cost/benefit and decide if they want the service.   

The point here, Jingle, isn't to argue with you, it's to refocus.  The problem ISN'T THE RATE, nor the "make up" practice.  it's the lack of transparency.   If the ENTIRE transaction - from negotiation to delivery to payment - was limited to the two parties, we'd be fine.  The doc could propose a rate, the patient could agree, and we move on.  But that's not how the U.S. healthcare system works.   

Essentially, our healthcare system is one big, massive example of me walking into my living room, seeing my kid comatose in front of the TV, me saying "what gives?" and my kid saying "Mom said I could."

Offline bosk1

  • Bow down to Boskaryus
  • Administrator
  • *****
  • Posts: 2601
  • Hard-hearted harbinger of haggis
Re: The ACA/Obamacare Thread
« Reply #600 on: August 01, 2017, 09:15:14 AM »
Stadler, I think you've done a good job of highlighting some of the specifics of what the actual problem is and why it generally isn't what it may seem on the surface.  But to go back to Chino's example and to play devil's advocate, despite that what you say about how the system generally works is true, it could also just be an example of a doctor who is somewhat of a crook.  Or who may not be a crook, but is overzealous about his billing when he shouldn't be.  Or whatever. 

But I say that to say that NO system can really prevent individual outliers who push the boundaries or prevent individuals from gaming the system and being crooks.  You can have penalties and sanctions that can act as a deterrent and/or to remedy the problem after the fact if these guys get caught.  But you can never 100% prevent all such abuses from even happening in ANY system.
"The Supreme Court of the United States has descended from the disciplined legal reasoning of John Marshall and Joseph Story to the mystical aphorisms of the fortune cookie."

Offline jingle.boy

  • DTF's resident deceased dictator
  • DTF.org Alumni
  • ****
  • Posts: 20861
  • Gender: Male
  • The changing of the worrd is inevitabre!!!
Re: The ACA/Obamacare Thread
« Reply #601 on: August 01, 2017, 10:11:35 AM »
The point here, Jingle, isn't to argue with you, it's to refocus.  The problem ISN'T THE RATE, nor the "make up" practice.  it's the lack of transparency.   If the ENTIRE transaction - from negotiation to delivery to payment - was limited to the two parties, we'd be fine.  The doc could propose a rate, the patient could agree, and we move on.  But that's not how the U.S. healthcare system works.   

Gotchya... and I ain't gonna argue any of that.  Despite the root cause being the system, I still think there's a responsibility on of those with the power (ie, Doctors have the power of providing the "care") not to take advantage of the system and/or those without the power.  The system allows for Chino's Doc to bill the way he did, and there isn't a damn thing anyone can do about it.  The doc billed it the way he did, because he could, and wasn't forthcoming with his patient.  Ethically questionable, IMO.  If he had told Chino "this is gonna cost $230", guaran-damn-tee (as Chino already said), he'd pass on it and go to Urgent Care.  So (and not saying this was intentional on the part of the Doc), his lack of transparency generated that income for him.

"Do no harm" I guess doesn't extend to insert "financial" before "harm". 

Essentially, our healthcare system is one big, massive example of me walking into my living room, seeing my kid comatose in front of the TV, me saying "what gives?" and my kid saying "Mom said I could."

 :rollin
Dream Theater Forums: Expanding musical tastes and shrinking wallets since 2009.
Note to forum, jingle is usually right.
I'm actually disappointed he's not Kim Jong-Il

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #602 on: August 01, 2017, 10:44:29 AM »
Stadler, I think you've done a good job of highlighting some of the specifics of what the actual problem is and why it generally isn't what it may seem on the surface.  But to go back to Chino's example and to play devil's advocate, despite that what you say about how the system generally works is true, it could also just be an example of a doctor who is somewhat of a crook.  Or who may not be a crook, but is overzealous about his billing when he shouldn't be.  Or whatever. 

But I say that to say that NO system can really prevent individual outliers who push the boundaries or prevent individuals from gaming the system and being crooks.  You can have penalties and sanctions that can act as a deterrent and/or to remedy the problem after the fact if these guys get caught.  But you can never 100% prevent all such abuses from even happening in ANY system.

Well, I agree, but there's this:   under the current system, there's NO controls.  The concept wasn't even discussed, and had it been covered by insurance, he never would have known.  Under a more transparent system, there STILL will be outliers, but there would be a large subset that would be an arm's length transaction, with checks and balances.  I don't think we should be trying to get a system where there is no possibility of malfeasance.  I think we should be trying to get a system that doesn't ACTIVELY PROMOTE malfeasance, and deal with the problem children as we go. 

Offline Dave_Manchester

  • Posts: 537
Re: The ACA/Obamacare Thread
« Reply #603 on: September 22, 2017, 02:19:33 PM »
McCain again proving a thorn in Trump's side...

http://www.bbc.com/news/world-us-canada-41367128

A wiser man than me (Lenin) once observed that taking a politician to the brink of his own death is the only sure way to haul a conscience out of him. I'm not saying that relates completely to McCain's refusal to vote for the new Repeal plan, but there is a definite trend I've noticed (British MPs Diane Abbott and Ronnie Campbell for example, both very ill with cancer now, and both no longer caring about "what's good for the Labour Party") of politicians setting aside idiotic party loyalty for the good of the country when they no longer have anything political to lose.

Offline El Barto

  • DTF.org Alumni
  • ****
  • Posts: 19074
  • Bad Craziness
Re: The ACA/Obamacare Thread
« Reply #604 on: September 22, 2017, 02:25:31 PM »
This was their sleaziest attempt yet. The formula they used in determining block grant amounts essentially took money from democrat states to give to republican states. And yet two GOP states that get shit on with this thing are Murkowski's and Collins's, whose vote they desperately needed.  :lol

As for McCain, I think it's pretty reasonable to assume he's just taking bullets for the team. Since he's leaving us he can afford to kill things so that sensible politicians with an actual future won't have to. I suspect that's why he thumb downed RAGFY. McConnel keeps putting his own folk in terrible situations. McCain keeps bailing them out.
Argument, the presentation of reasonable views, never makes headway against conviction, and conviction takes no part in argument because it knows.
E.F. Benson

Offline portnoy311

  • Posts: 815
Re: The ACA/Obamacare Thread
« Reply #605 on: September 22, 2017, 08:20:32 PM »
Yeah, this is so abysmal. I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them so they're trying to push things through while there's at least an outside chance. No, I don't think Republican = bad, Democrat = good - but I do think this Republican Congress and White House are proving to be toxic.


As for McCain, the one big former Washington insider (GOP) I'm friends with and routinely talk to HATES McCain. Always has. I've only half jokingly told him multiple times that makes me like John. To use a probably ridiculous analogy, he's like a "feel" poker player. There's two types of poker players - mathematically game theory centered players, and feel players. I'm the former (or was what I tried to be when I took it seriously, at this point I'm basically just a guy looking to have fun), whereas the latter are the stereotypical players who get a "read" based on whatever the hell, and go with it even if their overall strategy doesn't make sense. It only works if someone is really, really good at it as any small mistake can blow up on you quickly if you're not 100% right. That's John. He does whatever he thinks is right even if his overall strategy and principles aren't entirely coherent. I've never really vilified him like many on both sides of the aisle have. I think with how Congress is balanced right now he's incredibly important and an asset.
« Last Edit: September 22, 2017, 09:19:51 PM by portnoy311 »

Offline XeRocks81

  • Posts: 362
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #606 on: September 23, 2017, 08:23:08 AM »

 I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them

Man I'm sill too traumatized by the 2016 election to even think of saying something like that.   Feels like anything can happen now.

Offline pogoowner

  • Pancake Bunny
  • DTF.org Alumni
  • ****
  • Posts: 2836
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #607 on: September 23, 2017, 02:06:35 PM »
Yeah, this is so abysmal. I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them so they're trying to push things through while there's at least an outside chance.
Never underestimate the Democratic Party's ability to give away elections.

Offline El Barto

  • DTF.org Alumni
  • ****
  • Posts: 19074
  • Bad Craziness
Re: The ACA/Obamacare Thread
« Reply #608 on: October 13, 2017, 09:00:50 AM »
I'm really unsure of how killing the CSR program is going to effect the markets. Obviously it's bad for the insurance companies, but they've been operating under the assumption that he was going to do it all along (good ole republican predictability). They've been accounting for it for the last year. What I do know is that Trump now put his name on ACA. Had he let uncertainty kill the market the masses would have attributed much of its demise to Obama. Now that he actively blew it up it's on him. Moreover, it wouldn't surprise me if a few of the insurance companies came out and said as much. Last week they had a very good reason to not speak ill of the boy president. Now, not so much.

As so often seems to be the case, the message is more important to him than the practical ramifications. The upshot of this will be less options for the poor and sick, and rather than "we'll replace ACA with something beautiful," the message he's sending is "fuck the poor and sick."
Argument, the presentation of reasonable views, never makes headway against conviction, and conviction takes no part in argument because it knows.
E.F. Benson

Offline Chino

  • Be excellent to each other.
  • DT.net Veteran
  • ****
  • Posts: 19299
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #609 on: October 13, 2017, 10:35:22 AM »
I work in insurance and the industry began factoring this into all their prices as soon as Trump was elected.

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #610 on: October 13, 2017, 01:02:33 PM »
I'm really unsure of how killing the CSR program is going to effect the markets. Obviously it's bad for the insurance companies, but they've been operating under the assumption that he was going to do it all along (good ole republican predictability). They've been accounting for it for the last year. What I do know is that Trump now put his name on ACA. Had he let uncertainty kill the market the masses would have attributed much of its demise to Obama. Now that he actively blew it up it's on him. Moreover, it wouldn't surprise me if a few of the insurance companies came out and said as much. Last week they had a very good reason to not speak ill of the boy president. Now, not so much.

As so often seems to be the case, the message is more important to him than the practical ramifications. The upshot of this will be less options for the poor and sick, and rather than "we'll replace ACA with something beautiful," the message he's sending is "fuck the poor and sick."

Except... the CBO says that INITIALLY it will result in about a million people opting to not purchase insurance (because of cost) but starting in 2020, will lead to about a million people A YEAR GAINING coverage.  So by some point in 2021, we will have MORE people insured as a result of this change.   How can that be a bad thing?  Wasn't "Number of People Insured" the official Obama metric for the ACA to begin with (and wrongly, I might add)?   At least under the Trump method, we'll have MORE people insured but without the subsidies and penalties that forced compliance and therefore falsely inflated the numbers in favor of the ACA.  https://www.nbcnews.com/politics/politics-news/white-house-says-it-will-end-key-obamacare-subsidies-insurers-n810321

From the article:  "In August, the CBO reported (PDF) that ending the payments would raise the number of uninsured Americans by about 1 million in 2018 but would then start lowering the number of uninsured by about 1 million a year starting in 2020."

Offline gmillerdrake

  • Proud Father.....Blessed Husband
  • DTF.org Member
  • *
  • Posts: 10492
  • Gender: Male
  • 1 Timothy 2:5
Re: The ACA/Obamacare Thread
« Reply #611 on: October 13, 2017, 05:54:10 PM »
but they've been operating under the assumption that he was going to do it all along

I work in insurance and the industry began factoring this into all their prices as soon as Trump was elected.

Well that's because a Federal Judge ruled the CSR payments illegal, but obama kept dolling them out anyway. Of course the insurance companies have been prepping to do business without a facet of the ACA that has been ruled illegal.


https://www.forbes.com/sites/theapothecary/2016/05/12/judge-rules-administration-illegally-delivering-funds-to-insurers-participating-in-obamacare/#1d26dad16d68
Without Faith.....Without Hope.....There can be No Peace of Mind

Offline El Barto

  • DTF.org Alumni
  • ****
  • Posts: 19074
  • Bad Craziness
Re: The ACA/Obamacare Thread
« Reply #612 on: October 13, 2017, 06:10:07 PM »
but they've been operating under the assumption that he was going to do it all along

I work in insurance and the industry began factoring this into all their prices as soon as Trump was elected.

Well that's because a Federal Judge ruled the CSR payments illegal, but obama kept dolling them out anyway. Of course the insurance companies have been prepping to do business without a facet of the ACA that has been ruled illegal.


https://www.forbes.com/sites/theapothecary/2016/05/12/judge-rules-administration-illegally-delivering-funds-to-insurers-participating-in-obamacare/#1d26dad16d68
Which would make sense as the decision was under appeal. Trump then continued making the payments and has declined to drop the appeal up until yesterday.
Argument, the presentation of reasonable views, never makes headway against conviction, and conviction takes no part in argument because it knows.
E.F. Benson

Offline gmillerdrake

  • Proud Father.....Blessed Husband
  • DTF.org Member
  • *
  • Posts: 10492
  • Gender: Male
  • 1 Timothy 2:5
Re: The ACA/Obamacare Thread
« Reply #613 on: October 13, 2017, 06:45:24 PM »
but they've been operating under the assumption that he was going to do it all along

I work in insurance and the industry began factoring this into all their prices as soon as Trump was elected.

Well that's because a Federal Judge ruled the CSR payments illegal, but obama kept dolling them out anyway. Of course the insurance companies have been prepping to do business without a facet of the ACA that has been ruled illegal.


https://www.forbes.com/sites/theapothecary/2016/05/12/judge-rules-administration-illegally-delivering-funds-to-insurers-participating-in-obamacare/#1d26dad16d68
Which would make sense as the decision was under appeal. Trump then continued making the payments and has declined to drop the appeal up until yesterday.

the ruling itself explains why the insurance companies began planning for this since the ruling. They knew the chances of this being eliminated were pretty high. This wasn't 'republican predictability' this was inevitable.


Furthermore, it was an excellent political move by obama because he knew it was illegal also....yet, he also knew he could appeal it....it'd be tied up in court for a bit and either 1) it's struck down like it should be absolving him from any wrong doing or 2) a Republican President would nix it which he could then say 'they ruined my beautiful law' which any sane person paying any bit of attention knows this law is DEEPLY flawed yet 'look, Repubs broke obmamacare'    The law has always sucked since day one and I wish the Repubs would have never touched it and just let it blow up so there'd be no doubt about it. Now obama has an 'out' card which isn't quite historically fair.
« Last Edit: October 13, 2017, 06:50:33 PM by gmillerdrake »
Without Faith.....Without Hope.....There can be No Peace of Mind

Offline eric42434224

  • Posts: 3273
  • Gender: Male
  • Wilson
Re: The ACA/Obamacare Thread
« Reply #614 on: October 13, 2017, 08:46:24 PM »
Well, the good news is the Republicans have had 8 years to painstakingly craft their own well designed version of health care, and now with control of both the senate, house, and presidency, they will have no problem implementing it.
Oh shit, you're right!

rumborak

Rumborak to me 10/29

Offline kingshmegland

  • defender of the brew!
  • DTF.org Alumni
  • ****
  • Posts: 36509
  • Gender: Male
  • Take that Beethoven, you deaf bastard!!
Re: The ACA/Obamacare Thread
« Reply #615 on: October 13, 2017, 09:24:13 PM »
Well, the good news is the Republicans have had 8 years to painstakingly craft their own well designed version of health care, and now with control of both the senate, house, and presidency, they will have no problem implementing it.


I love your sarcasm because it rings so true. It's sad that we the constituents lose out in the end.
“I don't like country music, but I don't mean to denigrate those who do. And for the people who like country music, denigrate means 'put down'.” - Bob Newhart

So wait, we're spelling it wrong and king is spelling it right? What is going on here? :lol -- BlobVanDam

Offline gmillerdrake

  • Proud Father.....Blessed Husband
  • DTF.org Member
  • *
  • Posts: 10492
  • Gender: Male
  • 1 Timothy 2:5
Re: The ACA/Obamacare Thread
« Reply #616 on: October 14, 2017, 06:13:50 AM »
Well, the good news is the Republicans have had 8 years to painstakingly craft their own well designed version of health care, and now with control of both the senate, house, and presidency, they will have no problem implementing it.

Yeah. That's infuriating and really no good reason other than greed as to why they didn't come up with a fix. Can't raise campaign $$ if the largest issue is not an issue any longer. American politics at its 'finest'
Without Faith.....Without Hope.....There can be No Peace of Mind

Offline chknptpie

  • DTF.org Member
  • *
  • Posts: 2961
  • Gender: Female
Re: The ACA/Obamacare Thread
« Reply #617 on: October 15, 2017, 07:17:35 PM »
Is there an article or someone who can explain the "buy insurance across state lines" thing for me? I don't understand why I would want to buy insurance from California while living in Arizona. Doesn't that mean any doctor I see in Arizona is going to be out of network and cost an amazing amount of money?

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #618 on: October 16, 2017, 10:09:49 AM »
Yeah. That's infuriating and really no good reason other than greed as to why they didn't come up with a fix. Can't raise campaign $$ if the largest issue is not an issue any longer. American politics at its 'finest'

That's a somewhat watered down way of looking at it.   

Here's a thought experiment:   come up with a solution to a problem you will have eight years from now.   Make sure it's a comprehensive solution, that covers all the various stakeholders, from the rich down to the very poor, and make sure it survives bipartisan political scrutiny.   Also make sure that it is consistent and compliant with the minimum of three Supreme Court decisions that will come down in the meantime (you have to predict what the cases will be AND what the outcome will be; you can do it!).     Finally, make it work for 50 different jurisdictions that will also have their courts weighing in periodically over the eight year period.

It's not so much "American politics", but prudent legislating.   Not saying that the current process is flawed; clearly there is a bifurcation between the two wings of the Republican party that is stymying the progress (as well as skittishness on the part of some Republicans to commit to a path forward).   But to suggest that it is a failure of principle is not really an accurate assessment, in my opinion.   

Offline eric42434224

  • Posts: 3273
  • Gender: Male
  • Wilson
Re: The ACA/Obamacare Thread
« Reply #619 on: October 16, 2017, 10:15:06 AM »
It's also not accurate to say they had to come up with a solution 8 years ago to fit today.  They had 8 years to create a program and 8 years to tweak it to any issues that arose.  They should have had a program in place with more than 50% approval and it should have addressed any issues that arose.  There really is no excuse.   That gets you fired in the "real world"
Oh shit, you're right!

rumborak

Rumborak to me 10/29

Offline El Barto

  • DTF.org Alumni
  • ****
  • Posts: 19074
  • Bad Craziness
Re: The ACA/Obamacare Thread
« Reply #620 on: October 16, 2017, 10:31:21 AM »
I'm really unsure of how killing the CSR program is going to effect the markets. Obviously it's bad for the insurance companies, but they've been operating under the assumption that he was going to do it all along (good ole republican predictability). They've been accounting for it for the last year. What I do know is that Trump now put his name on ACA. Had he let uncertainty kill the market the masses would have attributed much of its demise to Obama. Now that he actively blew it up it's on him. Moreover, it wouldn't surprise me if a few of the insurance companies came out and said as much. Last week they had a very good reason to not speak ill of the boy president. Now, not so much.

As so often seems to be the case, the message is more important to him than the practical ramifications. The upshot of this will be less options for the poor and sick, and rather than "we'll replace ACA with something beautiful," the message he's sending is "fuck the poor and sick."

Except... the CBO says that INITIALLY it will result in about a million people opting to not purchase insurance (because of cost) but starting in 2020, will lead to about a million people A YEAR GAINING coverage.  So by some point in 2021, we will have MORE people insured as a result of this change.   How can that be a bad thing?  Wasn't "Number of People Insured" the official Obama metric for the ACA to begin with (and wrongly, I might add)?   At least under the Trump method, we'll have MORE people insured but without the subsidies and penalties that forced compliance and therefore falsely inflated the numbers in favor of the ACA.  https://www.nbcnews.com/politics/politics-news/white-house-says-it-will-end-key-obamacare-subsidies-insurers-n810321

From the article:  "In August, the CBO reported (PDF) that ending the payments would raise the number of uninsured Americans by about 1 million in 2018 but would then start lowering the number of uninsured by about 1 million a year starting in 2020."
That's a good read. I was familiar with the tax credits rising once the premiums increased, but hadn't seen it applied to nothing but a termination of the CSRs. There are a couple of things I'll point out, though. This is based on nothing but the CSR termination. Grabby is doing other things, as well, which will muddle the tea leaves. More unknowns decrease the accuracy of the predictions. The other problem is that I don't subscribe to the "number of insured" metric any more than you do. My metric has always been "number of people who need insurance that can now get it." I don't see this being helpful to them anytime soon. Lastly, the increased tax credits don't help everybody. I'm not eligible, so all I get are the higher premiums.
Argument, the presentation of reasonable views, never makes headway against conviction, and conviction takes no part in argument because it knows.
E.F. Benson

Offline Stadler

  • DTF.org Alumni
  • ****
  • Posts: 9884
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #621 on: October 16, 2017, 10:35:00 AM »
Is there an article or someone who can explain the "buy insurance across state lines" thing for me? I don't understand why I would want to buy insurance from California while living in Arizona. Doesn't that mean any doctor I see in Arizona is going to be out of network and cost an amazing amount of money?

There are a number that argue both sides, in well-regarded financial resources like Forbes and the Wall Street Journal (both have excellent articles on both side of the issue).   

In short, removing the restrictions would be a way of keeping insurers honest and providing for a check and balance on the major actors, including the insurers, the regulators, the legislatures, and the providers.  Healthcare is very heavily regulated, at the state level.  So what you get is in one or two states you have maybe one or two major players, and no one else that can compete.  Those players - who have the resources to have duplicative systems and resources in place for multiple states - can then lobby state legislatures and you get regulations that bolster their quasi-monopoly.   If it's "GMDrake's Insurance" and "Stadler's Insurance" in Arizona, and as such, we have all the doctors "in network", then "Chknptpie's Insurance" - based in California - is basically barred from coming in and providing an alternative.   If "Chknptpie's Insurance" could legally sell in Arizona then they too could add those doctors to their network, so that's not the issue.  But now we'd have the competition from more players, and you'd lose some of the lobbying power that the monopolies have built up.  Over time, the regulations would have to be more amenable to out-of-state participation (uniformity) and you'd lose the need to have multiple schemes and systems for every state.    You'd also get a better chance of having smaller, regional players in to help cut costs.   You'd gain an invaluable way of keeping a realistic check and balance on GMDrake's Insurance or Stadler's Insurance, and the regulations they work under.   

I live in Northern Connecticut, literally seven miles from the Massachusetts border.  I am in Hartford County, so even though Hartford the city is 25 minutes (as the crow flies; hour and 15 with traffic) from me, and Springfield, Mass is 15, even with traffic, I am basically "governed" by the providers and rates of Hartford.  My kid is nine (and likely on the spectrum; he's to be comprehensively tested in November) and has weekly therapy and monthly doctor visits with two different doctors, and I can't use providers in Massachusetts without an incredible hassle and a shit ton of paperwork. 

All this layering adds cost and decreases transparency.   It's not a be-all and end-all (though I have said in the past that if I could change ONE THING it would be the "interstate regulatory scheme") but it would be a huge first step to getting the costs down which in turn would reduce the need for subsidies, reduce the cost of premiums, and increase the number of people that will be insured.   

Offline Cable

  • Posts: 1510
  • Gender: Male
---

Offline Cool Chris

  • DTF.org Alumni
  • ****
  • Posts: 5062
  • Gender: Male
  • Rest in Peace
Re: The ACA/Obamacare Thread
« Reply #623 on: October 26, 2017, 07:50:57 PM »
Curious on everyone's thoughts on today's opiod announcement. Seattle is wanting to creates free sites (er... I mean taxpayer funded sites) staffed with medical personnel for junkies to shoot up. Because letting them kill themselves "safely" is preferable to letting them do it efficiently I guess. I'd rather offer them a "Let's Make a Deal" offer: Door #1: Jail for 90 days, Door #2: Monitored housing with a 40-day work week doing community service and rehab services, Door #3: A one-way bus ticket out of town. I haven't heard any local politicians advocating for any of those options.
"Nostalgia is just the ability to forget the things that sucked" - Nelson DeMille, 'Up Country'

Offline El Barto

  • DTF.org Alumni
  • ****
  • Posts: 19074
  • Bad Craziness
Re: The ACA/Obamacare Thread
« Reply #624 on: October 26, 2017, 07:59:29 PM »
Whether your aim is to be a hardass or a Samaritan, feel good legislation is never as useful as a pragmatic approach. I suspect you'll get more than you bargain for, though. Sessions will be far more of a hardass than you, and clearly the problem is that we just didn't put enough druggies in jail for long enough the first time.
Argument, the presentation of reasonable views, never makes headway against conviction, and conviction takes no part in argument because it knows.
E.F. Benson

Offline Cool Chris

  • DTF.org Alumni
  • ****
  • Posts: 5062
  • Gender: Male
  • Rest in Peace
Re: The ACA/Obamacare Thread
« Reply #625 on: October 26, 2017, 08:41:45 PM »
Just realized I put this in the ACA thread when I meant it for the main one. But it is a health issue. So, 1/2 point for me.

If you don't like Feel Good legislation, don't come to Seattle.

At least if these junkies are in jail, they aren't living in tents across the street and stealing Amazon packages from my communities' porches. If they wanted to get clean, we'd be happy to help them. But they refuse to go to any facility where they have to live by those darn rules. So mandatory detox and rehab is my plan. Slightly better than a growing zombified criminal segment of our population.
"Nostalgia is just the ability to forget the things that sucked" - Nelson DeMille, 'Up Country'

Offline cramx3

  • Chillest of the chill
  • DTF.org Alumni
  • ****
  • Posts: 16178
  • Gender: Male
    • The Home of cramx3
Re: The ACA/Obamacare Thread
« Reply #626 on: October 27, 2017, 07:25:14 AM »
I have really mixed feelings about the safe places for shooting up.  It just feels wrong, but apparently it's helpful.  I've had a family friend die of an overdose.  I've seen how it affects the family.  It's not something you can easily fix.   My good cop friend has used Narcan way too many times in our small town.  I have mixed feelings about that too.  I have some radical personal ideas, but I don't think those are real solutions. 

Offline Chino

  • Be excellent to each other.
  • DT.net Veteran
  • ****
  • Posts: 19299
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #627 on: October 27, 2017, 07:34:49 AM »
Relevant

https://www.heraldnet.com/news/some-damage-undone-thousands-of-heroin-needles-removed/

Steph “Boston” Gaspar, 43, sifts through a pile of thousands of needles Monday after volunteers spent a weekend cleaning a homeless camp off Avondale Road south of Everett. (Caleb Hutton / The Herald)

Offline kaos2900

  • Posts: 1974
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #628 on: October 27, 2017, 07:58:18 AM »

Offline Cable

  • Posts: 1510
  • Gender: Male
Re: The ACA/Obamacare Thread
« Reply #629 on: October 27, 2017, 10:40:15 AM »
I guess this can go here?

https://www.washingtonpost.com/news/wonk/wp/2017/10/26/why-cvs-health-would-want-to-buy-aetna/?utm_term=.e98e8be065fb

*sigh*

I work for a big name insurance company, I don't see anything good about this.


I'm with you from my perspective, personally and professionally. But what is yours Kaos, from your professional angle?
---