Healthcare going forward

[gsdx]

I am sure you have your own private meaning of the word like so many other ideosyncratic meaning you give to other words.

I know what 'boondoggle' means. What is your definition?

 

[thewiz]

Many of the them would be back where they were before this boondoggle. Where will they be if nothing is done and the system collapses? They had Medicaid before and will continue to have it in expanded form. Or they can go to Canada which wants "refugees".

The bullshit Republican line that the existing ACA is "collapsing" is just another in a series of lies. First, the Republicans like to tout how prices for policies are going up and up -- which they were before the ACA but at a much faster rate. The ACA could be tweaked to improve its existing circuit breaker system by lowering the income levels required for assistance under ACA. No one is paying $1,000 increases unless they are too stupid to file the necessary paperwork or they are lying about their income. My plan, on the exchange (and a gold plan) DECREASED in price the first year (by more than 30%) before going up 12% this year. That compares to when I used to purchase insurance for our city employees and would have danced had we been able to see but a 12% increase (prior to ACA the rates were increasing 20% or more) . Under ACA, if premium increases do not hit individuals; the circuit breaker contained in the existing legislation requires a higher payment by the federal government in the form of tax credits that are paid BEFORE the individual pays. Under the Republican plan, the individual pays and then, when filing his/her income tax, receives a credit AFTER. That's great unless the person is making so little they don't pay taxes in which case they also get nothing. So their $300 current monthly plan suddenly becomes $1,200 and they are not reimbursed (if ever) until a year later. It's much like the system we had prior to ACA and we all know where that goes -- people drop coverage because they simply can't afford it.

Of course, under Ben's scenario they can either die or seek care and then declare bankruptcy. Hospitals, medical providers, doctors, and others eat the cost of treating these patients because they'll never be reimbursed. To offset their losses, they simply mark up prices so those with insurance or the cash to pay, suddenly are faced with double the prices (I know, I've sat on a hospital board that had to determine what to charge based on our uncompensated care, Medicare reimbursement rates, and types of insurance held by our customer base). That $400 room suddenly becomes $900 and all of the associated treatment is increased. It is not sustainable.

The Republican plan also eliminates payment by the wealthy that covered the costs in ACA. I realize they need another $30,000 or $500,000 per year to add to their growing piles of wealth so let's just let those people rot on the street and they can drive around them in their BMW's and non-American made vehicles. Those who are close to the line may struggle and continue to pay the higher premiums but that requires not purchasing the iPhone, new television, new clothes, perhaps a dinner out. Those that provide the services mentioned then find themselves out of work. Hell, even Walmart figured out that cycle doesn't work.

The lie that the system was collapsing is simply not true. Insurance companies were dropping out because of grenades planted by Republicans (Marco Rubio bragged how he eliminated funding co-ops for coverage to pre-existing conditions). The other challenge was that half the Republican governors did not establish exchanges or offer coverage -- which not only denied their citizens coverage but it also minimized the insurance pools. In some states -- Arizona for instance -- the large elderly population that has pre-existing conditions and is a big user of pharmaceuticals, does not have enough younger, healthy people to stabilize premiums (that were subsidized in the first year of the ACA). That resulted in higher price increases but those could easily be offset with the tax credits and not end up hurting anyone (unless they didn't qualify which also means they earn much more).

The Republican plan should have allowed broader exchanges to provide a better pool, instituted caps on prices, and managed care. I love how they want to provide "a market approach." When you are having your heart attack or stroke or have a leg dangling because it was nearly amputated in a car accident -- ask the EMS driver if they could pull over while you check on-line for best prices in your area. Then call those providers and see if they might be having discounts on the day of your need or maybe you've even clipped a coupon. Sound stupid? That's the Republican plan.

- - - Updated - - -

I know what 'boondoggle' means. What is your definition?

I think my definition of late would be synonymous with the word "Republican."

 

[Benvolio]

I was surprised that North Dakota was so high on the list since as a major oil-producing state. In the latest numbers, they did move down (even though oil production is down and the price of oil is well under the previous price). Part of North Dakota's problem is one that is shared with many midwestern states- an aging population and depopulation as younger citizens leave the state. North Dakota had about 700,000 residents- less than the tiny states of Delaware and Rhode Island and less than most major cities in the US.

Other midwestern states, including Kansas, Nebraska, Ohio, Minnesota are near the very bottom. I think a better answer for ND is that it has several Native American Reservations.

 

[TX-Beau]

Other midwestern states, including Kansas, Nebraska, Ohio, Minnesota are near the very bottom. I think a better answer for ND is that it has several Native American Reservations.

Reservations are not under the jurisdiction of the States, except for Texas. Any healthcare or social services on Reservations (don't fool yourself that these exist), and any hospitals on those reservations, are operated by the BIA paid for by the Fed.

It's just bigotry to assert that the poverty of the Natives forced onto those Reservations is what is dragging down White People.

Not that anyone expects anything but nasty racism from Ben in the first place.

Always when white people have problems, it's some brown person's fault.

 

[KaraBulut]

That $400 room suddenly becomes $900 and all of the associated treatment is increased. It is not sustainable.

That's a deal. The private pay rate for most of the hospitals that I work with are over $1,500 per day that goes up to $4,000 for a critical care room.

I saw a recent bill for an ACA patient for a cath lab procedure that lasted about 2 hours with no inpatient room charge. Before write-down, it was an $80,000 bill. Because the patient had an ACA PPO plan, the contract price was $15,000 and the hospital wrote off the $65,000 difference as a contractual adjustment. As you know, if that patient was uninsured, she would have been on the hook for the $80,000.

In some states -- Arizona for instance -- the large elderly population that has pre-existing conditions and is a big user of pharmaceuticals, does not have enough younger, healthy people to stabilize premiums (that were subsidized in the first year of the ACA).

The rates in Arizona were not realistic in the beginning. The rates before 2017 were in the $250-400 range for a Silver plan. That's why the anti-ACA crowd always cites a percentage increase when talking about the 2017 Silver rates in Arizona- when the plans went up to $400-1000 it looked like the rates doubled when in fact they are more in line with the rates in most states (before subsidies). The 2017 rates in Arizona for the over 55 year olds are pretty brutal and that's what the Congress should be working on fixing.

As you know the over 55 rates are capped at 3x the lowest rate, so that's why they raised the low rates- so they could triple that for the seniors. It's one of the reasons that the AARP (or in Spicer's words, the "special interest groups") is up in arms about the possible repeal of the ACA.

The lie that the system was collapsing is simply not true. Insurance companies were dropping out because of grenades planted by Republicans

Most of the problems with payer participation in the ACA could be fixed with a simple rule- that insurance companies cannot bid on state or federal employee insurance contracts unless they are participating in the state's exchanges. Aetna, United Healthcare and Cigna would be back on the exchange in a heartbeat.

Other midwestern states, including Kansas, Nebraska, Ohio, Minnesota are near the very bottom. I think a better answer for ND is that it has several Native American Reservations.

No, it's more likely because of farm subsidies.... to North Dakotan farming corporations.

Dakota Indians have casinos. They don't need subsidies just because they're brown.

 

[Kulindahr]

http://www.cnbc.com/2017/03/09/the-republican-health-care-bill-threatens-trumps-voters.html


The Republicans are going to try to bash this through, hoping that by the mid-terms the voters will have forgotten.

But they could end up losing bigly because of the lies they all have been telling.

I know some Trump supporters who are getting really irritated. He talked big, they believed him, but all anyone has seen so far is a circus -- no brilliant new ideas, just putzing around with too many statements that don't bear much resemblance to reality.

 

[Kulindahr]

I know what 'boondoggle' means. What is your definition?

It doesn't matter. Accusing people of having "idiosyncratic" definitions is just one of his moves for avoiding having to admit his philosophy is just a bigoted version of social Darwinism. His use of words isn't connected to reality anyway, just to his imagined binary world of simplistic concepts.

 

[Kulindahr]

The bullshit Republican line that the existing ACA is "collapsing" is just another in a series of lies. First, the Republicans like to tout how prices for policies are going up and up -- which they were before the ACA but at a much faster rate.

From a certain perspective it appears to be collapsing. But if so, then it's collapsing far more slowly than things were before.

I suspect that the biggest objection to the ACA by so-called conservatives is that it forces a much more honest accounting than before.

I also find it amusing that they can support Reagan, who essentially imposed an unfunded mandate on hospitals by requiring people to be aided regardless of ability to pay. On that point, I am reminded of a sign in the hospital my mom was in recently, which pointed out that they have helped people regardless of the ability to pay ever since their founding (long before Reagan) -- but they were fairly unique on that, having a large Christian backing happily covering the costs.

 

[Kulindahr]

Other midwestern states, including Kansas, Nebraska, Ohio, Minnesota are near the very bottom. I think a better answer for ND is that it has several Native American Reservations.

Interesting possibility. Since the article didn't tell us what all was being counted as tax dollars coming back to the states, we've no way to know.

But that gives us three reasons for ND so far -- lots of highway miles per capita, an aging population, and the reservations -- that we can't verify from the source.

 

[Kulindahr]

Reservations are not under the jurisdiction of the States, except for Texas. Any healthcare or social services on Reservations (don't fool yourself that these exist), and any hospitals on those reservations, are operated by the BIA paid for by the Fed.

It's just bigotry to assert that the poverty of the Natives forced onto those Reservations is what is dragging down White People.

Not that anyone expects anything but nasty racism from Ben in the first place.

Always when white people have problems, it's some brown person's fault.

Um, what? That doesn't bear much resemblance to his post. Reservations get federal dollars, and that's tax money being returned to the state -- it's a legitimate possibility for some of the dollars ND gets back. He didn't say anything about "dragging down White People".

That said -- and conceding that my knowledge of reservation affairs is a good quarter century out of date -- I don't see the per capita return of federal dollars to natives as being much higher than for anyone else. Things would have to have changed a lot for this to be a major factor.

 

[Kulindahr]

Most of the problems with payer participation in the ACA could be fixed with a simple rule- that insurance companies cannot bid on state or federal employee insurance contracts unless they are participating in the state's exchanges. Aetna, United Healthcare and Cigna would be back on the exchange in a heartbeat.

What a Reagan-like solution -- either play with the rest of us, or get locked out!

No, it's more likely because of farm subsidies.... to North Dakotan farming corporations.

Dakota Indians have casinos. They don't need subsidies just because they're brown.

Ouch -- I didn't even think about farm subsidies. That's something that needs fixing; agricultural subsidies should only go to those for whom they were originally intended: the farmers who live and work on their land.
Republicans should be swarming to support that reform -- they're enthusiasts for "original intent", right?

I almost mentioned casinos, but I wasn't sure. Thanks!

 

[TX-Beau]

Um, what? That doesn't bear much resemblance to his post. Reservations get federal dollars, and that's tax money being returned to the state -- it's a legitimate possibility for some of the dollars ND gets back. He didn't say anything about "dragging down White People".

That said -- and conceding that my knowledge of reservation affairs is a good quarter century out of date -- I don't see the per capita return of federal dollars to natives as being much higher than for anyone else. Things would have to have changed a lot for this to be a major factor.

Reservations don't pay tax dollars to the state and usually the Fed either. They get "return" from everyone paying into the Fed based on the Trust obligations (the Fed declaring them all wards of the state and taking "in trust" their welfare and property) and Treaty agreements entered into by the Fed (except Texas.) If you include them in some kind of "return" you also have to acknowledge that they didn't contribute to the income tax base, are not under the jurisdiction of the States (which have no power to tax them in the first place.) Saying they are why ND is getting more than they pay in, is at best a gross oversimplification since ND isn't obligated to pay for them and doesn't take taxes from them.

It's more complicated than that but that is basically the situation on most reservations. It's also the reason people like Trump went to Natives and offered to finance their casinos (he fucked them over - big shock) no taxes, no local jurisdictions.

Ben is saying that ND is getting more BECAUSE of Reservations. That's bunk, no matter the state of ND's finances, they didn't pay any more for the reservation than CA did. They also took no taxes from the reservation. Pretending that is the cause that people in ND who pay their income taxes and then THEMSELVES take more from the Fed is just lying.

 

[TX-Beau]

OH YEAH, also there aren't very many of them around anymore, so even if there were no Reservations their impact on the system is minimal. The reason for all of this is that the fed appointed itself trustee for the Tribes and promised healthcare and education, and various other things in various places usually in "return" for land (except Texas.) It's a contractual agreement entered into by the Fed that doesn't rely on taxation or returns on taxation and including this in a discussion of that is not helpful. Every State pays for every Reservation (if they have any social services at all) at the same rate.

They are usually a special case because of the way Reservations were Incorporated (or not) into the body politic, but what is always true, is that there is no way to generalize the way Tribal affairs impact the state. It's simply too different in too many places where you have hugely wealthy "Casino" tribes of 250 people and poor tribes like Navajos with over a million. Palm Springs in CA is literally reservation, then state, every other block.

 

[TX-Beau]

HA, here, ND isn't getting anything "back" for Reservations, and Reservations never put anything "in" for ND.

None of the cash the Fed spends on a Reservation, is available to be spent in ND, there is no "return." If that cash isn't spent on a reservation in ND, it will be spent on a Reservation elsewhere.

 

[Benvolio]

That's a deal. The private pay rate for most of the hospitals that I work with are over $1,500 per day that goes up to $4,000 for a critical care room.

I saw a recent bill for an ACA patient for a cath lab procedure that lasted about 2 hours with no inpatient room charge. Before write-down, it was an $80,000 bill. Because the patient had an ACA PPO plan, the contract price was $15,000 and the hospital wrote off the $65,000 difference as a contractual adjustment. As you know, if that patient was uninsured, she would have been on the hook for the $80,000.


The rates in Arizona were not realistic in the beginning. The rates before 2017 were in the $250-400 range for a Silver plan. That's why the anti-ACA crowd always cites a percentage increase when talking about the 2017 Silver rates in Arizona- when the plans went up to $400-1000 it looked like the rates doubled when in fact they are more in line with the rates in most states (before subsidies). The 2017 rates in Arizona for the over 55 year olds are pretty brutal and that's what the Congress should be working on fixing.

As you know the over 55 rates are capped at 3x the lowest rate, so that's why they raised the low rates- so they could triple that for the seniors. It's one of the reasons that the AARP (or in Spicer's words, the "special interest groups") is up in arms about the possible repeal of the ACA.



Most of the problems with payer participation in the ACA could be fixed with a simple rule- that insurance companies cannot bid on state or federal employee insurance contracts unless they are participating in the state's exchanges. Aetna, United Healthcare and Cigna would be back on the exchange in a heartbeat.


No, it's more likely because of farm subsidies.... to North Dakotan farming corporations.

Dakota Indians have casinos. They don't need subsidies just because they're brown.

Farm subsidies cannot begin to explain why ND is at the top while Kansas and Nebraska are near the bottom. Nor do highways explain it. It may be related to the sudden expansion of the oil industry in ND and later decline.

 

[gsdx]

How did we get from healthcare to farm subsidies?

 

[TX-Beau]

How did we get from healthcare to farm subsidies?

Ben is trying to justify why Red States tend to suck more off the Federal teat than they ever put in.

The answer is that the Red States are generally the poorer ones with the worst education.

 

[Kabluey]

Ben is trying to justify why Red States tend to suck more off the Federal teat than they ever put in.

The answer is that the Red States are generally the poorer ones with the worst education.

Apparently Jeebus doesn't pay the bills.

 

[KaraBulut]

Reservations don't pay tax dollars to the state and usually the Fed either....

It's more complicated than that but that is basically the situation on most reservations.

It's been a couple of decades since I worked with the Indian Health Service but from my experiences there in the 80s, it was as bad as Africa (only with lots of alcoholism). From what I'm hearing from counterparts in public health is that the casinos have significantly improved conditions since the 80s- financial and otherwise- for the tribes. One of the problems that they're having to deal with is that they've never had to run businesses and manage money, so they've had a learning curve of how to manage too much money.

OH YEAH, also there aren't very many of them around anymore, so even if there were no Reservations their impact on the system is minimal.

In addition to the treaty obligations for things like education and healthcare, there's a big budget allocated under BIA for land and water management. It's incredibly complicated but apparently there's a large amount land in trust that the Feds manage but that's a different budget from the budget subsidies that we were originally discussing before this latest Benvolio derail.

Correct me if I'm wrong since you know more about Indian financing than I- but the assumption that Indians are paupers supported by the Feds is a stereotype and because of casinos and other tribal investments, they're not as socially subsidized as other populations.

Ben is trying to justify why Red States tend to suck more off the Federal teat than they ever put in.

The answer is that the Red States are generally the poorer ones with the worst education.

I'm not going to justify his desperate attempts to somehow link federal subsidy to anything other than "white people" but it is fair to say that what these states have in common is a dying tax base (ergo the term "rust belt") and an aging, infirm population.

The reason that states like Georgia, Texas and Kansas don't show up in the top 10 can be summed up by a look at the finances of cities like Atlanta, Dallas, Houston, Austin, Topeka and Kansas City- vibrant cities with growing populations and dynamic economies.

 

[rareboy]

I'm loving the agony of the Red state governors who are going to lose Medicaid expansion.