Healthcare going forward

[Benvolio]

Well, it was my thread to start with and I would like to see it go forward if we could get back to the original question of what is the best way forward for health care in the US. One would think that being in power the Republicans could work with the Democrats to make a fairly conservative idea of an insurance marketplace like Obamacare work if they were only willing to move past their own rhetoric. That has always been the interesting thing about this to me if a Republican president had fielded this idea they would be calling it genius.

It still seems to me that the only real major problem is stabilizing the marketplaces so insurance companies have some stability and assurance of success.

'Insurance" of preexisting illnesses cannot work. You cannot gouge health people enough to give the charity to those with preexisting illnesses. So stabilizing is not the major problem.

 

[Stardreamer]

'Insurance" of preexisting illnesses cannot work. You cannot gouge health people enough to give the charity to those with preexisting illnesses. So stabilizing is not the major problem.

Then how do YOU suggest dealing with preexisting conditions in the marketplace?

 

[Benvolio]

Then how do YOU suggest dealing with preexisting conditions in the marketplace?

I do not think you can. Ultimately it would require payment by the federal and/or state governments. Medicaid serves that purpose.

 

[Stardreamer]

I do not think you can. Ultimately it would require payment by the federal and/or state governments. Medicaid serves that purpose.

Exactly, that is one of the options opening up Medicaid to all to provide a basic level of care for those who cannot obtain insurance.

 

[KaraBulut]

Well, it was my thread to start with

Just pointing out that several topics that have been discussed keep getting brought up, even though it's already been documented that the information and statements by one particular member are false. It's a much like watching a dog chasing its tail. There's plenty to discuss but anytime the facts become clear, another fact-free derail starts.

...and I would like to see it go forward if we could get back to the original question of what is the best way forward for health care in the US. One would think that being in power the Republicans could work with the Democrats to make a fairly conservative idea of an insurance marketplace like Obamacare work if they were only willing to move past their own rhetoric.

For years, everyone has described Medicare as being the "third rail" of politics- a popular program that is lethal for anyone who attempts to make significant modifications.

What we're seeing is that healthcare as a whole has become the third rail. Some of the problem can be attributed to the fact that we're discovering that the general public doesn't understand healthcare delivery systems- in the US or elsewhere. The disinformation campaigns from both political parties (and special interest groups) has also poisoned the well.

Hillary Clinton's failed attempt to introduce a public option in 1993 was still something that hurt her in 2016. The ACA hung like a cloud over the Obama administration for 7 years after it was passed (even though people still don't understand what "Obamacare" really was). The Republican's attempt to pass the AHCA will come back to haunt them in 2018.

In the meantime, Medicare is slowly sliding into insolvency (the ACA changes extended the insolvency date to 2028 but the financing still needs to be addressed today).

The current government needs to pass another continuation of the overall budget by April 28th in order to avoid a government shutdown (heard anyone even talking about something that is 20 days away?).

Trump still has over 500 political appointments that require Senate approval that he hasn't even made nominations for.

Syria.

So, no- healthcare is unlikely to get any traction in 2017.

 

[Kulindahr]

'Insurance" of preexisting illnesses cannot work.

That right there is a great statement of why insurance, for medical care, is an immoral system.

You cannot gouge health people enough to give the charity to those with preexisting illnesses.

And that is a great demonstration of the fact that you just don't pay attention to others here as people -- all you do is read words and react as though we're just things to be fired at with talking points (even if those points have been debunked or discredited).

If you feel as though people here don't treat you with respect, it's just your own attitude coming back at you.

 

[Kulindahr]

Just pointing out that several topics that have been discussed keep getting brought up, even though it's already been documented that the information and statements by one particular member are false. It's a much like watching a dog chasing its tail. There's plenty to discuss but anytime the facts become clear, another fact-free derail starts.

I'd say it's more like watching a pig wallow in its own excrement.

 

[Kulindahr]

For years, everyone has described Medicare as being the "third rail" of politics- a popular program that is lethal for anyone who attempts to make significant modifications.

What we're seeing is that healthcare as a whole has become the third rail. Some of the problem can be attributed to the fact that we're discovering that the general public doesn't understand healthcare delivery systems- in the US or elsewhere. The disinformation campaigns from both political parties (and special interest groups) has also poisoned the well.

Hillary Clinton's failed attempt to introduce a public option in 1993 was still something that hurt her in 2016. The ACA hung like a cloud over the Obama administration for 7 years after it was passed (even though people still don't understand what "Obamacare" really was). The Republican's attempt to pass the AHCA will come back to haunt them in 2018.

In the meantime, Medicare is slowly sliding into insolvency (the ACA changes extended the insolvency date to 2028 but the financing still needs to be addressed today).

The current government needs to pass another continuation of the overall budget by April 28th in order to avoid a government shutdown (heard anyone even talking about something that is 20 days away?).

Trump still has over 500 political appointments that require Senate approval that he hasn't even made nominations for.

Syria.

So, no- healthcare is unlikely to get any traction in 2017.

That it is unlikely to get any traction is probably good -- so long as the GOP is in charge, we;re looking at health care going backwards.

 

[frankfrank]

the base is stuck on the idea that all of Obamacare must be repealed NOW, before any meaningful discussion of what healthcare should be, we are all doomed to some vague financial disaster.

Yeah, repeal ACA (Obamacare) and go back to the days where it took 50, 60, 70 YEARS to finally get healthcare through Congress. Do we want the shit pre-ACA system again? Repeal Obamacare without a sensible replacement ALREADY IN PLACE, and rest assured that, unless you are RICH, nobody reading this can ever expect good healthcare again.

Then how do YOU suggest dealing with preexisting conditions in the marketplace?

I do not think you can. Ultimately it would require payment by the federal and/or state governments. Medicaid serves that purpose.

JUST "LET THEM DIE," THEN?? Consider that he has always been entirely against the Medicaid expansion in the states, so his comment is entirely hollow and disingenuous. He doesn't want pre-existing conditions to be covered...and he wants Medicaid for NOBODY because it's...get ready...SOCIALISM!!!!

 

[KaraBulut]

That it is unlikely to get any traction is probably good -- so long as the GOP is in charge, we;re looking at health care going backwards.

There's some cognitive dissonance to the issue at the moment. The public statements are things like "Obamacare is failing", "Obamacare is in a death spiral" or "Obamacare has ruined healthcare in America" which is hyperbole.

The overall ACA legislation is lowering the overall cost of healthcare and it is reducing the Federal deficit. The ACA and HITECH have pushed hospitals and physician practices to put in electronic systems that make healthcare more efficient. The legislation has also put in incentives for physicians who keep their patients well versus rewarding physicians who only treat patients when they get sick.

There are two problems that need to be dealt with: the individual market (which covers about 13 million people) and pharmaceutical pricing.

The same companies that are pulling out of the individual market are the same companies that are making a lot of money in the Federal employee, State employee, Medicare Advantage and Medicaid Managed Care programs. If the Feds were to write a rule saying that none of these companies would participate in these Federally-subsidized insurance markets unless they also participated in the Marketplace, the individual market problem would be solved in every State.

The participation in the individual market has still been low because the $695 yearly penalty is lower than the cost of the policies. If they were to increase the penalty significantly then the participation in the individual Marketplace would increase.

There are still 19 states that have refused to expand Medicaid. The feds need to sweeten the deal to get these states to expand Medicaid.

There are some financial incentives paid by the Federal government that encourage insurance companies to participate in the individual market. These were not in the original law and if Congress were to end these incentives, it would trigger all of the insurance companies to exit the Marketplace citing financial insolvency. Congress needs to look at these cost-sharing incentives and formally add them to the ACA.

On the cost issue, Trump made promises in his stump speeches claiming that he would do something to lower the cost of prescription drugs. When he met with executives from the pharmaceutical industry in January, he did not push them on the pricing issue; instead, most of the discussions were promises from Trump to reduce red tape and cut the regulations around drug testing and safety.

The other big change that Congress could make is to allow Medicare and Medicaid to negotiate for pharmaceutical discounts. Under Medicare D, Medicare was prevented from negotiating drug prices. Much of the insolvency issues for Medicare and much of the profitability issues of the ACA individual plans centers on drug prices. If Medicare were to negotiate prices (which the VA current does), it would put provide a disincentive for hedge funds to jack up prices and it would also eliminate costs that are associated with pharmaceutical wholesalers that inflate the prices.

 

[Stardreamer]

So thanks to Benviolio's input and agreement that a free market healthcare system will not work, I guess we move on to what is the best and most fiscally sound way to shore up Medicaid/Medicare and make it available to all who need it as a baseline safety net. Or if those systems are not adequate, what alternative healthcare system could be implemented that would be fiscally sounder?

I know there are those on the right who would say none but that answer seems incorrect since every other major industrialized nation seems to manage the issue. So while I don't rule that answer, I would say that if you present that as an answer you will have to demonstrate why all the various alternatives will not work in the US when they work elsewhere. Note that simply saying the American people will not stand for it is not an adequate answer, it is simply saying that the American people are Sodomites. I for one do not think that is true, we simply have deluded ourselves about social responsibilities.

 

[kallipolis]

Much of the insolvency issues for Medicare and much of the profitability issues of the ACA individual plans centers on drug prices. If Medicare were to negotiate prices (which the VA current does), it would put provide a disincentive for hedge funds to jack up prices and it would also eliminate costs that are associated with pharmaceutical wholesalers that inflate the prices.

Well noted.

 

[gsdx]

instead, most of the discussions were promises from Trump to reduce red tape and cut the regulations around drug testing and safety.

Undoubtedly leaving them with more and more profits, more than enough to pay off all of the class-action lawsuits and still leave a healthy amount to stuff in their pockets.

With all the lawsuits popping up every day, I would hasten to say that the testing and safety laws aren't good enough to stop people from dying.

 

[Stardreamer]

There's some cognitive dissonance to the issue at the moment. The public statements are things like "Obamacare is failing", "Obamacare is in a death spiral" or "Obamacare has ruined healthcare in America" which is hyperbole.

The overall ACA legislation is lowering the overall cost of healthcare and it is reducing the Federal deficit. The ACA and HITECH have pushed hospitals and physician practices to put in electronic systems that make healthcare more efficient. The legislation has also put in incentives for physicians who keep their patients well versus rewarding physicians who only treat patients when they get sick.

There are two problems that need to be dealt with: the individual market (which covers about 13 million people) and pharmaceutical pricing.

The same companies that are pulling out of the individual market are the same companies that are making a lot of money in the Federal employee, State employee, Medicare Advantage and Medicaid Managed Care programs. If the Feds were to write a rule saying that none of these companies would participate in these Federally-subsidized insurance markets unless they also participated in the Marketplace, the individual market problem would be solved in every State.

The participation in the individual market has still been low because the $695 yearly penalty is lower than the cost of the policies. If they were to increase the penalty significantly then the participation in the individual Marketplace would increase.

There are still 19 states that have refused to expand Medicaid. The feds need to sweeten the deal to get these states to expand Medicaid.

There are some financial incentives paid by the Federal government that encourage insurance companies to participate in the individual market. These were not in the original law and if Congress were to end these incentives, it would trigger all of the insurance companies to exit the Marketplace citing financial insolvency. Congress needs to look at these cost-sharing incentives and formally add them to the ACA.

On the cost issue, Trump made promises in his stump speeches claiming that he would do something to lower the cost of prescription drugs. When he met with executives from the pharmaceutical industry in January, he did not push them on the pricing issue; instead, most of the discussions were promises from Trump to reduce red tape and cut the regulations around drug testing and safety.

The other big change that Congress could make is to allow Medicare and Medicaid to negotiate for pharmaceutical discounts. Under Medicare D, Medicare was prevented from negotiating drug prices. Much of the insolvency issues for Medicare and much of the profitability issues of the ACA individual plans centers on drug prices. If Medicare were to negotiate prices (which the VA current does), it would put provide a disincentive for hedge funds to jack up prices and it would also eliminate costs that are associated with pharmaceutical wholesalers that inflate the prices.

Just so!
The application of your suggestions would pretty much solve most of the problems.

The one thing that keeps batting around in my mind is providing some sort of automatic catch all. What if instead of the tax penalty simply being a punitive penalty, could we turn it into some sort of automatic premium/enrollment in a Medicaid type system? Not sure that would work out fiscally though without expanding the current Medicaid tax somewhat. The idea though is that even if you don't get insurance there would be a system that would ensure that your costs for care are not being inefficiently passed on to everyone else, which is the situation now.

Admittedly it is a backdoor approach to universal care but we have to start someplace if we are to keep Trump's promises of coverage for everyone.

 

[KaraBulut]

...if those systems are not adequate, what alternative healthcare system could be implemented that would be fiscally sounder?

...The one thing that keeps batting around in my mind is providing some sort of automatic catch all. What if instead of the tax penalty simply being a punitive penalty, could we turn it into some sort of automatic premium/enrollment in a Medicaid type system?

These are related question, so let's back up a bit and keep in mind what the ACA individual market was designed to do: the idea was that the government would allow private insurance companies to insure people who a) didn't have insurance through their employer and b) worked but made too much to qualify for Medicaid.

The stats on the people who are in the individual Marketplace show that a significant portion of them don't qualify for Medicaid because they are working (either self employed or employed part-time) and are above the federal poverty line requirements for Medicaid. So, it wouldn't be possible to auto-enroll them in Medicaid because they wouldn't pass the financial requirement for Medicaid.

The first question that the US has to ask itself is whether they are still committed to having private insurance for the 13 million or so people in the Marketplace. There's a faction on the left who would be happy to see the ACA individual market fail so that the Federal government steps in an creates a public option- basically allowing money that would normally be paid to private insurance companies go toward a Medicare type system that insured people who fell into category a) and b) above.

A public option would provide automatic coverage for those who make too much to go into Medicaid and haven't signed up for the Marketplace.

However, if the government doesn't want to create a public option, they have little choice but to fix the Marketplace.

Undoubtedly leaving them with more and more profits, more than enough to pay off all of the class-action lawsuits and still leave a healthy amount to stuff in their pockets.

With all the lawsuits popping up every day, I would hasten to say that the testing and safety laws aren't good enough to stop people from dying.

There's a couple of things going on here-
First, the public thought they voted for a populist who was going to "bring back jobs". What's happening is a Koch Brother/Mercer family wet dream of deregulation promises for big businesses: basically, an undoing of the New Deal programs that were put in place to prevent ups and downs in the economy and to balance power between citizens and corporations.

Second, it is important to remember that the FDA is there for a reason and you're correct: there's a lot of red tape that is there to ensure that drugs that come on the market aren't harmful and that they do what they're advertised to do.

During the HIV epidemic, AIDS activists put pressure on Congress and the FDA to create two tracks for medication approval. Drugs that are critical can go through the expanded access program as an investigation drug; 99% of expanded access applications are approved. Other non-critical medications go through the normal process because they are either non-critical or there is already a medication on the market that is in the same class.

PhRMA is the major lobbying group for Big Pharma. They were the ones who got the regs into both Medicare D and the ACA that prevented the government from negotiating drug prices.

After they met with Trump, PhRMA put out a statement summarizing what was discussed after the public portion of the meeting:
“We discussed many areas of common ground, including advancing stronger trade agreements to level the playing field with countries around the world, reforming our tax code to spur investment and job creation here in the U.S., and removing outdated regulations that drive up costs and slow innovation.”
"We believe if these policies are enacted, it will translate to up to 350,000 new jobs over the next 10 years as a result of growth in the biopharmaceutical industry.”

Given the two tracks that exist at the FDA, you have to ask yourself, "Would deregulation bring down drug costs? Would deregulation bring needed antibiotics and drugs that prevent disease to the market?".

Or put another way, "How many ED drugs do we really need? How many restless leg syndrome drugs do we need? How many drugs for plaque psoriasis do we need?". These drugs are the ones that cost $2,000 to $15,000 per month and must be taken every month for life... and they're where most of the new drug research and marketing is focused upon.

 

[Kulindahr]

The same companies that are pulling out of the individual market are the same companies that are making a lot of money in the Federal employee, State employee, Medicare Advantage and Medicaid Managed Care programs. If the Feds were to write a rule saying that none of these companies would participate in these Federally-subsidized insurance markets unless they also participated in the Marketplace, the individual market problem would be solved in every State.

Someone really devious should introduce legislation mandating that sanctuary cities not get federal dollars and that companies not participating in the Marketplace stop getting payments through federal programs and/or Medicare-Medicaid -- apply the same principle to both issues and show who's a hypocrite and who's not.

 

[Kulindahr]

The other big change that Congress could make is to allow Medicare and Medicaid to negotiate for pharmaceutical discounts. Under Medicare D, Medicare was prevented from negotiating drug prices. Much of the insolvency issues for Medicare and much of the profitability issues of the ACA individual plans centers on drug prices. If Medicare were to negotiate prices (which the VA current does), it would put provide a disincentive for hedge funds to jack up prices and it would also eliminate costs that are associated with pharmaceutical wholesalers that inflate the prices.

That would actually be simple. The on-line pharmacy I use negotiates drug prices; it's why I can get a prescription with pills that normally cost over a dollar a pill at ten to fifteen cents per pill. All that's needed is to insist that for the sake of the free market Medicare and Medicaid have to be allowed to do the same things private companies can do.

Arguing it that way would show just how hypocritical the GOP is being about this -- they really aren't in favor of a free market, they're in favor of law-boosted profit. Level the playing field.

 

[Kulindahr]

So thanks to Benviolio's input and agreement that a free market healthcare system will not work, I guess we move on to what is the best and most fiscally sound way to shore up Medicaid/Medicare and make it available to all who need it as a baseline safety net. Or if those systems are not adequate, what alternative healthcare system could be implemented that would be fiscally sounder?

I know there are those on the right who would say none but that answer seems incorrect since every other major industrialized nation seems to manage the issue. So while I don't rule that answer, I would say that if you present that as an answer you will have to demonstrate why all the various alternatives will not work in the US when they work elsewhere. Note that simply saying the American people will not stand for it is not an adequate answer, it is simply saying that the American people are Sodomites. I for one do not think that is true, we simply have deluded ourselves about social responsibilities.

There's a simple step that should be done anyway that would make a small start here: for purposes of all federal programs, count anyone as disabled who is counted that way by any federal agency, not just Social Security. It shouldn't matter if the VA, SS, IRS, or whatever calls you disabled, you should count as disabled.

Then take the disabled category and anyone earning under 130% (I think that's the ACA figure) of the federal poverty level and just enroll them in Medicare, plus a refundable tax credit for the total cost of Medicaid. That would cover the most needy, taking a huge chunk off the bottom where things are worst.


For another step, raise the amount companies are required to pay out in benefits to 82% by 2018, 84% by 2020, and 85% by 2022. If my insurance company can manage things with an administrative overhead in the single digits, so can the others.

 

[Kulindahr]

... what alternative healthcare system could be implemented that would be fiscally sounder?

I know there are those on the right who would say none but that answer seems incorrect since every other major industrialized nation seems to manage the issue. So while I don't rule that answer, I would say that if you present that as an answer you will have to demonstrate why all the various alternatives will not work in the US when they work elsewhere. Note that simply saying the American people will not stand for it is not an adequate answer, it is simply saying that the American people are Sodomites. I for one do not think that is true, we simply have deluded ourselves about social responsibilities.

Good job noting that the sin of Sodom was not homosexuality, but refusal to take care of those in need!

 

[ballcaphair]

I believe that you are both partially correct. Being in the "business" one of the first entries in ALL admission docs is insurance information. This even applies to ER. As a one-time uninsured individual, I did not have the leverage of Medicare or insurance to have my costs "adjusted." For those of us who make enough to fall through the cracks, we pay full fare. We absorb costs not covered by other's Mediwhatever and insurance companies. I've made payments on my treatment and see clients everyday who will struggle financially while I am charting every move I make to stave off litigation. I'm not opposed to businesses making profits, but this industry is very top heavy even with captive consumers. I believe any RETHINKING must be client based, not provider defined. So I think this discussion is essential and appreciated. Keep bringin' Brothers.