Healthcare going forward

[Benvolio]

On ambulances especially I have to agree; thanks to the ACA, we have enough ambulances to serve our town.

As for saving.... I'm still working on paying off medical debt from years ago. That's why I've always laughed at the health savings account idea -- those who can afford to have one generally won't need one.

Why cannot your town buy its own ambulances? Why should others have to pay. Savings accounts are good for those with occasional small expenses. Admittedly they will not solve the problem of major medical expenses. And many lack either the income or the frugality to save.

 

[thewiz]

Unfortunately obamacare is so unprofitable for the insurance companies that many have left it. https://www.bloomberg.com/view/arti...-sign-that-obamacare-exchanges-are-collapsing
Thus my question was whether the GOP plans will keep obamacare from collapsing. It appears now that the Republicans will have difficulty arriving at an agreed plan and that obamacare will fail by default.

What the press fails to understand (along with Congress) is that insurance companies have to file their pricing with the states in which they operate -- in April. The states then have hearings and decide whether those prices are appropriate and the approval is usually given about September of each year for the upcoming year. The Republicans have planted a hand grenade in the pricing system because insurance companies are unable to file prices for something of which they know nothing. Will they be expected to cover pre-existing conditions? Will they have to allow children on parents plans until 26? Will there be no life time caps? Will insurance companies be able to spend however they want on anything but covering expenses for those they sell to?

While my prices are locked in for this year, look for a real cluster come 2018. The closer this goes to April, the more likely the entire system is likely to explode.

As for your question on ambulances -- all cities DO buy their ambulances. The problem is that most cities are lucky to collect 50% of their bill under the system prior to ACA since many patients calling for transport did not have insurance. There is something to be said for not getting blood out of a turnip. With the ACA, cities were billing and collecting close to 80% of their charges which is a huge amount that covers the cost of staffing and purchasing/replacing equipment. You might not be aware but cities (and states) can't print money and spend whatever. They have to run a balanced budget and so collecting or billing is the only way to pay for services delivered at the local level.

In addition to higher collection rates, the ease of collection and standardization of forms/billing along with electronic payment is a huge assistance to cities and hospitals (thank you ACA). Our small, rural hospital used to see receivables aging well past 180 days on a regular basis; I believe their rate is down to 45 to 90 days now. There is no reason that payments are not received in 14 days using electronics but insurance companies like to sit on that money as long as possible before paying the bills.

 

[rareboy]

Over 600,000 people went bankrupt because of medical care in the US.

What the fuck is wrong with a country where that happens.

 

[Kabluey]

Why cannot your town buy its own ambulances? Why should others have to pay. Savings accounts are good for those with occasional small expenses. Admittedly they will not solve the problem of major medical expenses. And many lack either the income or the frugality to save.

What kind of hick country expects every little town to fund its own ambulance service?
Next you'll be saying local towns have to fund their own cops, schools and fire services.
Should each have its own military service too?

At some point it all resembles feudalism.

 

[Stardreamer]

Vox: The puzzling way Republicans want to replace the individual mandate, explained with a cartoon

I found this quite eye opening. By replacing the individual mandate with the continuous coverage idea, Republicans have taken a system that punishes you for not having insurance to a system that rewards you for not having it and punishes you for trying to get it. This is a formula for INCREASING costs and premiums.

Since healthy people are punished for restarting coverage, they might decide to hold out until they get sick.

Meanwhile, sicker people might be more willing to pay the penalty since they need care.

That leads to a sicker insurance pool, higher costs for everyone who has coverage, and even less incentive for healthier people to join the pool.

 

[Benvolio]

What kind of hick country expects every little town to fund its own ambulance service?
Next you'll be saying local towns have to fund their own cops, schools and fire services.
Should each have its own military service too?


At some point it all resembles feudalism.

Of course they pay for cops, schools and fire services as well as ambulances. Why should someone else pay? Other people have their own services to pay for. It has no resemblance to feudalism.

 

[KaraBulut]

What kind of hick country expects every little town to fund its own ambulance service?
Next you'll be saying local towns have to fund their own cops, schools and fire services.
Should each have its own military service too?

At some point it all resembles feudalism.

Actually, he's arguing against a Republican mantra: usage fees. Since the ACA pays for ambulance services, it's paying a portion of the charges for those who actually use its services. Under the old system, taxpayers for the county had to bear the cost for unreimbursed EMS and ambulance services.

Ooopsie. He didn't get that talking point correct.

 

[Stardreamer]

So since Trump is now endorsing it can we officially start calling it Trumpcare?

 

[Kulindahr]

It's interesting that Rand Paul and Tom Price keep bring up "insurance choice" and "high risk pools" to revive those plans that had low lifetime max and high deductibles. Very few providers would accept those plans before the ACA eliminated them altogether.


The $500 million in Medicaid services that goes to Planned Parenthood for women's well-care cannot be replaced by the existing system, so you are correct- the burden will shift to the emergency rooms and the already overburdened public health clinics.


One thing also to add that is a very important change from the ACA: it eliminated the segregation of medical and mental health services. All ACA plans had to cover mental health services under the medical benefit.

Why is this important? Because we have a jail system that is full of people who should be in drug and alcohol rehab programs. And we have a problem with opiate addictions in the very southern and midwestern states that elected Trump. By eliminating Medicaid coverage for these patients, we will shift the burden back to the very expensive criminal justice system.


There were some interesting articles in the press over the past year about how profitable some of the ACA plans were for the insurance companies. In the case of Aetna, they were caught lying to the press about why they pulled out from the Obamacare exchanges.... turns out they were trying to coerce the Justice Department into approving the merger with Humana.

Judge: Aetna lied about quitting Obamacare

If a company's official representative lies to the government (including in court) under oath, the company should be fined 90% of its profits for one quarter per lie. The money should be put into am untouchable endowment fund, the income from which would be used to provide grants at 3% interest for starting businesses.

 

[Kulindahr]

As for your question on ambulances -- all cities DO buy their ambulances. The problem is that most cities are lucky to collect 50% of their bill under the system prior to ACA since many patients calling for transport did not have insurance. There is something to be said for not getting blood out of a turnip. With the ACA, cities were billing and collecting close to 80% of their charges which is a huge amount that covers the cost of staffing and purchasing/replacing equipment. You might not be aware but cities (and states) can't print money and spend whatever. They have to run a balanced budget and so collecting or billing is the only way to pay for services delivered at the local level.

In addition to higher collection rates, the ease of collection and standardization of forms/billing along with electronic payment is a huge assistance to cities and hospitals (thank you ACA). Our small, rural hospital used to see receivables aging well past 180 days on a regular basis; I believe their rate is down to 45 to 90 days now. There is no reason that payments are not received in 14 days using electronics but insurance companies like to sit on that money as long as possible before paying the bills.

Our fire department now has two ambulances, both brand new (they sold the old one), and the hospital now has at least two (I don't know if they got the third one that was being talked about).

I remember when a tenant in the apartment house my dad owned had a heart attack and was take to the hospital in a sheriff's car because the fire department's ambulance was in the shop and the hospital's was out at a wreck. If that person had lived out of town, she would likely have died because the sheriff's car had very limited medical equipment.

 

[Kulindahr]

Over 600,000 people went bankrupt because of medical care in the US.

What the fuck is wrong with a country where that happens.

What kind of hick country expects every little town to fund its own ambulance service?
Next you'll be saying local towns have to fund their own cops, schools and fire services.
Should each have its own military service too?

At some point it all resembles feudalism.

It's social Darwinism, and it's the policy of the GOP no matter how loudly they deny it. It shows that they do not believe that we are a people but just a collection of individuals in the social jungle, with no obligations to each other. They want half the social contract, the one under which they have rights, but not the half which entails obligations.

If this is going to be the pattern under Trump, then his "Make America Great Again" is meaningless, because the word "America" has no real content.

 

[Kulindahr]

Of course they pay for cops, schools and fire services as well as ambulances. Why should someone else pay? Other people have their own services to pay for. It has no resemblance to feudalism.

Except they don't. Oregon has a significant number of towns that can't afford to pay for cops, fire services, or ambulances because they are required to pay for schools, and that laves nothing over.

The GOP view is that those towns should just suffer and eventually die. The irony of that is that when people move from small towns to larger ones, and especially to cities, they become more likely to vote for Democrats. In its own interest, the GOP should be building a plan that takes care of rural and small towns very, very well!

And no, other people do not "have their own services to pay for": larger cities have larger tax bases and can afford to pay for the things you listed plus others, like better parks and even opera houses. There are more streets to maintain, too, but there are more people per square foot of paved street in a city than in rural areas or small towns.

It's truly amusing to watch Republicans propose policies which in the long run will turn many of their voters into Democrats.

 

[Kulindahr]

Actually, he's arguing against a Republican mantra: usage fees. Since the ACA pays for ambulance services, it's paying a portion of the charges for those who actually use its services. Under the old system, taxpayers for the county had to bear the cost for unreimbursed EMS and ambulance services.

Ooopsie. He didn't get that talking point correct.

Yeah -- according to the money gal at the hospital here, before the ACA barely a quarter of ambulance services were paid for; after the ACA that flipped to the reverse. It still doesn't cover the costs of the ambulance services, but thanks to the difference they could turn donor money to buying a run-down half-block across from the hospitals immediate care clinic, tearing it down, and replacing it with garage for ambulances with housing for the drivers next to and above those.

IIRC they donated two of the houses that were removed, intact, to Habitat for Humanity, which fixed them up structurally enough to move them, and finished them completely afterward, giving two homeless families actual homes.

 

[Kulindahr]

So since Trump is now endorsing it can we officially start calling it Trumpcare?

Except fewer people will get care and those who do will get worse care, it would be more appropriate to drop the T and just call it rumpcare. Or maybe salvage the D fro the original family name and call it dumpcare.

 

[Kulindahr]

What really irritates me is that the plan bows down to the power of corporations and guilds and rewards them for the pitiful job they do. That's anti-market! There are no market reforms there to bump competition levels and thus bring down costs. At the very least, they should take that $600 billion and instead of providing a tax cut for the wealthy use it to build new medical schools -- I think we could get some pretty bloody good medical schools, each with its own endowment for merit-based scholarships, at a billion a pop.

And if the AMA doesn't want to play, then let anyone unhappy with the AMA form a competitor organization... or two. Better, don't even ask the AMA, just offer a million bucks for getting organized for any medical folks who want to form a rival to the AMA.

 

[frankfrank]

Our small, rural hospital used to see receivables aging well past 180 days on a regular basis; I believe their rate is down to 45 to 90 days now. There is no reason that payments are not received in 14 days using electronics but insurance companies like to sit on that money as long as possible before paying the bills.

Yeah, another reason I am happy to be moving to a big city. It's already my understanding that Macomb IL is "no place to have a heart attack" - you just might not survive it here. I can even imagine that the hospital could fold, if health care collapses...or, perhaps, become little more than a large clinic. People in this town WILL DIE if anything like that (or massive reductions in competent services and doctors) happens.

When I had my kidney removed [cancerous] in 2003, the insurance took FIVE GODDAMNED FUCKING **MONTHS** to pay their part of it! I just, VERY narrowly, avoided having my entire bill go to Collection, which would have undoubtedly added thousands of dollars to it. In the end, it also turned out that I was paying more than $7,000 per year for SHIT insurance. The bill was over $26K and the insurance paid only about $12K of that and I had to pay the rest. I didn't DARE contest anything farther, and perhaps even lose all of what they were paying.

Totally fucked up system here.

What kind of hick country expects every little town to fund its own ambulance service?
Next you'll be saying local towns have to fund their own cops, schools and fire services.
Should each have its own military service too?

Oh yeah, and they also have to entirely fund the roads or highways that connect their towns to the national grid, so some place like Lander, Wyoming had better be ready to ante-up for maintaining about 100 miles of highway. No federal highway WELFARE for you!

 

[Kulindahr]

When I had my kidney removed [cancerous] in 2003, the insurance took FIVE GODDAMNED FUCKING **MONTHS** to pay their part of it! I just, VERY narrowly, avoided having my entire bill go to Collection, which would have undoubtedly added thousands of dollars to it. In the end, it also turned out that I was paying more than $7,000 per year for SHIT insurance. The bill was over $26K and the insurance paid only about $12K of that and I had to pay the rest. I didn't DARE contest anything farther, and perhaps even lose all of what they were paying.

Totally fucked up system here.

A few years back my actual insurance company was farming things out to different other companies. I had one insurance for doctor, one for hospital and ER, a different one if I was put in the hospital, another for medications, and so on.

I had an accident and in the course of getting help I needed some tests done. That was in March, and by the time the insurance companies stopped bickering over which one had to cover the lab costs, it was July...
of the NEXT YEAR.

I fondly think that my complaints over the situation had something to do with the changes that came a couple of years later, but now I have one coverage for all things medical as out-patient, another for in-patient, another for meds, and another for mental health -- and oddly enough my dental coverage is through the same outfit as mental health. The only thing I have to watch out for now is if I get a blood test for PTSD meds I don't dare get blood tests for medical reasons at the same time or I'll be right back in that same limbo. And one result of that is a greater cost to me and the insurance companies when I have to do separate sets of blood work on separate days just to keep the paperwork (and my anxiety) straight.

 

[Kulindahr]

Oh yeah, and they also have to entirely fund the roads or highways that connect their towns to the national grid, so some place like Lander, Wyoming had better be ready to ante-up for maintaining about 100 miles of highway. No federal highway WELFARE for you!

I've written to my senators about that one. I figure for starters that any highway with a "U.S." on it should get federal funds, and they all ought to be getting brought up to speed. Unfortunately, the money we would have plentifully to do that is being spent on interest on the debt.

 

[rareboy]

So, 24 hours later and it looks dead on arrival.

The conservatives hate it, calling it a 'Republican Entitlement Program' and 'Obamacare Lite'.

Let's see what the CBO makes of it.

 

[rareboy]

So what about Trump's promise of health insurance for 'everybody'?

It is clear that this bill doesn't even make an attempt to do that.