Healthcare going forward

[Stardreamer]

So, at last, the Senate Parliamentarian is coming out to remind Republicans that you just can't put anything in a reconciliation bill. The language below would have to be removed from the bill or it would require a full 60 votes instead of the 50 the Republicans are trying to use.

- Provision defunding Planned Parenthood since it focuses on a single entity and not a general budget item.

- Restrictions on tax credits forbidding them to be used on insurance plans that provide abortions.

- Appropriations for cost sharing reduction subsidies (the funds that Trump is blackmailing insurers with), reconciliation bills cannot appropriate new funds only repeal them.

- The rule that persons who have a break in coverage would have to wait six months before they get new insurance.

- Provisions dealing specifically with New York State's Medicaid program, the bill cannot single out one state in its provisions.

Further provisions such as the Cruz Amendment are still be evaluated.

Parliamentarian deals setback to GOP repeal bill

 

[Kulindahr]

Are you speaking of the freedom to die in the streets? Yea, let's bring that back.

I think he means the freedom to tell those with less means "Fuck off and die!" and let them die in the streets.

The freedom to piss on your fellow citizens and feel righteous about it is not one America was founded to uphold.

 

[thewiz]

How easily socialism and welfare become ingrained. How quickly freedom is lost and how difficulty regained.

I notice those on the far right love to throw large words like "socialism" around without really understanding or knowing what the hell they are talking about.

Socialism, by definition, is a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

The Affordable Care Act did not seize ownership of health insurance; quite the contrary. Instead, following the Heritage Foundation and Republican ideas, it utilized the existing market system to deliver insurance with a goal of coverage to all Americans. The individual was free to choose what company they used (I had 28 choices last year). I think ACA should have gone further with a single payer system which would prove more economical and have the ability for things like group purchases, directing services to affordable areas and truly impact the cost side of the equation that people like Ben and the Republican Czars now claim to seek.

But then they'd be throwing around the regurgitated word "communism" I suppose.

 

[gsdx]

I notice those on the far right love to throw large words like "socialism" around without really understanding or knowing what the hell they are talking about.

But... but... he's a lawyer!

Just like Trump, he finds new ways every day to lower his credibility. I've warned him about doing his homework. Google is just a click away.

 

[Stardreamer]

I notice those on the far right love to throw large words like "socialism" around without really understanding or knowing what the hell they are talking about.

Socialism, by definition, is a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

The Affordable Care Act did not seize ownership of health insurance; quite the contrary. Instead, following the Heritage Foundation and Republican ideas, it utilized the existing market system to deliver insurance with a goal of coverage to all Americans. The individual was free to choose what company they used (I had 28 choices last year). I think ACA should have gone further with a single payer system which would prove more economical and have the ability for things like group purchases, directing services to affordable areas and truly impact the cost side of the equation that people like Ben and the Republican Czars now claim to seek.

But then they'd be throwing around the regurgitated word "communism" I suppose.

I gather the orginal law even provided a mechanism to deal with the problem of insurers not being able to support rural and other underserved markets by allowing for a co-op type system in those areas. Like so many of the other mechanisms in the ACA it was sabotoged and underfunded by the Republican congress.

 

[Benvolio]

I notice those on the far right love to throw large words like "socialism" around without really understanding or knowing what the hell they are talking about.

Socialism, by definition, is a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

The Affordable Care Act did not seize ownership of health insurance; quite the contrary. Instead, following the Heritage Foundation and Republican ideas, it utilized the existing market system to deliver insurance with a goal of coverage to all Americans. The individual was free to choose what company they used (I had 28 choices last year). I think ACA should have gone further with a single payer system which would prove more economical and have the ability for things like group purchases, directing services to affordable areas and truly impact the cost side of the equation that people like Ben and the Republican Czars now claim to seek.

But then they'd be throwing around the regurgitated word "communism" I suppose.

ACA initiates nearly total regulation of the health care in the US. But, more specifically, the federal government requires everyone to have health insurance but then subsidizes the premiums for those who it deems unable to afford them. KaraBulut informs us that 85% of enrollees get subsidies so that the insureds pay next to nothing. The government paying for the insurance is another form of "single payer" insurance, which is euphemism for socialism.

 

[thewiz]

I gather the orginal law even provided a mechanism to deal with the problem of insurers not being able to support rural and other underserved markets by allowing for a co-op type system in those areas. Like so many of the other mechanisms in the ACA it was sabotoged and underfunded by the Republican congress.

The original law did exactly that....and was sabotaged by one Senator Marco Polo Rubio. He bragged about it; it collapsed the markets up your way. And now they blame Obama and the Dems! No shame but easily Googled.

 

[ballcaphair]

The original law did exactly that....and was sabotaged by one Senator Marco Polo Rubio. He bragged about it; it collapsed the markets up your way. And now they blame Obama and the Dems! No shame but easily Googled.

Spot on. ACA made us put another hole in our belts, which were tight to begin with. Across the board it actually helped our Clinic's clients though. The sketchy future is already terrifying our clients and us as well. Only the rich are optimistic.

 

[Benvolio]

Spot on. ACA made us put another hole in our belts, which were tight to begin with. Across the board it actually helped our Clinic's clients though. The sketchy future is already terrifying our clients and us as well. Only the rich are optimistic.

How did you get along before ACA?

 

[frankfrank]

^ Your account reminds me of 1982 when two friends (yes, a committed M-M couple) were losing their jobs at a mental institution in northern Illinois, because it was being shuttered - to be repurposed as a prison.

They had formed strong bonds with a number of the patients. Some of these patients came up to my friends, shaking and crying and in utter fear, afraid that they were going to die. They had nowhere to go, and they weren't being shifted off to other institutions - they were simply being made homeless.

The institution gave them $50 and a one-way bus ticket to Chicago and, other than that, they were on their own. (My friends are sure that some of these people probably did die on sidewalks, etc. This was also in the middle of winter.)

We all actually had to hope that, if they didn't find somebody to stay with, they may have turned to some kind of crime - enough to at least put them into jail. That's a horrific solution, but probably the only other alternative that might actually keep them from dying, because other options didn't exist.

 

[Kulindahr]

ACA initiates nearly total regulation of the health care in the US. But, more specifically, the federal government requires everyone to have health insurance but then subsidizes the premiums for those who it deems unable to afford them. KaraBulut informs us that 85% of enrollees get subsidies so that the insureds pay next to nothing. The government paying for the insurance is another form of "single payer" insurance, which is euphemism for socialism.

If it's socialism, it's National Socialism, because it's a system where government and for-profit business are intertwined.

 

[ballcaphair]

How did you get along before ACA?

Honestly, meds were slightly higher, but mainly clients with preexisting conditions were cornered with or without insurance. Med A stayed aabout the same. But treatment took a backseat.

 

[Benvolio]

Honestly, meds were slightly higher, but mainly clients with preexisting conditions were cornered with or without insurance. Med A stayed aabout the same. But treatment took a backseat.

One way or another patients were covered, including Medicaid. Now we are told without government control millions will die in the streets or some such thing.

 

[Julian89]

Apply pressure to these Senators. Call. Organize protests. 2018 is just next year.
Flake - Arizona
Fischer - Nebraska
Wicker - Mississippi
Heller - Nevada
Corker - Tennessee
Cruz - Texas
Hatch - Utah
Barasso - Wyoming

2020 is not that far either
Cotton - Arkansas
Gardner - Colorado
Perdue - Georgia
Ernst - Iowa
Roberts - Kansas
McConell - Kentucky
Cassidy - Louisiana
Cochran - Mississippi
Daines - Montana
Sasse - Nebraska
Tillis - North Carolina
Inhofe - Oklahoma
Graham - South Carolina
Rounds - South Dakota
Alexander - Tennessee
Cornyn - Texas
Capito - West Virginia
Enzi - Wyoming

I think its time for Democrats to do a genuine Red State tour. Sen. Bernie Sanders has already started in Kentucky and West Virginia. Let us bring the fight to them. Register prospective voters. Help them passed thru their draconian state ID laws. Aside from Senator Sanders, I pray that other Democrats can be credible enough to engage the electorate in the Red States. I cannot think of any at the moment. I am thinking the likes of Rep. Tulsi Gabbard and former Ohio State Senator Nina Turner. Perhaps they should give it a shot as well.

 

[KaraBulut]

ACA initiates nearly total regulation of the health care in the US.

Hardly. One only needs to look at the pricing issue to realize that your statement lands somewhere between hyperbole and fiction.

KaraBulut informs us that 85% of enrollees get subsidies so that the insureds pay next to nothing.

It is true but let's look at why.

First of all, it's important to know that the 85% of people who get subsidies are NOT getting 100% of their premium paid. It is a sliding scale based upon your income ("means-tested"). Most people are paying a portion of the premium.

The subsidies are means tested. That means that in order to get the subsidy, you have to go through a Federal Poverty Level (FPL) evaluation and have your income for last year reviewed on Healthcare.gov.

FPL for an individual is $12,060/yr. For a family of 4 it is $24,600/yr. There's some variances because not all States accepted the expanded Medicaid but people near or below the FPL are eligible for Medicaid. Those who don't qualify for Medicaid but are at 400% of FPL can apply for subsidies to help with the cost of private insurance.

The individual market covers a variety of people- small business owners, farmers, part-time workers and people who work but don't get employer-based insurance (and who don't qualify for Medicaid).

The subsidy concept is no different that employer-based insurance, by the way. Employer-based insurance still covers about 49% of Americans and most of this cost is paid by insurers. The employer-paid premiums not taxed as benefits to employees (a loophole that dates back to the 1930s).

Employer group policies are about $20,000 per employee and employers pay about 60-70% of that cost. So, basically people who have employer-based insurance are getting about $15,000 in tax-free benefits.

The government paying for the insurance is another form of "single payer" insurance, which is euphemism for socialism.

So?

I mentioned this in an earlier post: most countries have some form of public health insurance. This shifts the benefit burden from employers to the government. This reduces the cost of employment and makes businesses more competitive. One of the reasons that the US auto industry has gotten their asses kicked for 40 years is that their overseas competitors aren't having to foot the bill for an extra $15-25K per employee for healthcare costs.

If the US wants to "Make America Great Again", to increase employment and rebuild it's manufacturing sector, they're going to have to look at both the cost of healthcare and the burden of employer-based insurances. Until they do, there's little hope that any large manufacturing base will return to the US.

 

[Benvolio]

Hardly. One only needs to look at the pricing issue to realize that your statement lands somewhere between hyperbole and fiction.


It is true but let's look at why.

First of all, it's important to know that the 85% of people who get subsidies are NOT getting 100% of their premium paid. It is a sliding scale based upon your income ("means-tested"). Most people are paying a portion of the premium.

The subsidies are means tested. That means that in order to get the subsidy, you have to go through a Federal Poverty Level (FPL) evaluation and have your income for last year reviewed on Healthcare.gov.

FPL for an individual is $12,060/yr. For a family of 4 it is $24,600/yr. There's some variances because not all States accepted the expanded Medicaid but people near or below the FPL are eligible for Medicaid. Those who don't qualify for Medicaid but are at 400% of FPL can apply for subsidies to help with the cost of private insurance.

The individual market covers a variety of people- small business owners, farmers, part-time workers and people who work but don't get employer-based insurance (and who don't qualify for Medicaid).

The subsidy concept is no different that employer-based insurance, by the way. Employer-based insurance still covers about 49% of Americans and most of this cost is paid by insurers. The employer-paid premiums not taxed as benefits to employees (a loophole that dates back to the 1930s).

Employer group policies are about $20,000 per employee and employers pay about 60-70% of that cost. So, basically people who have employer-based insurance are getting about $15,000 in tax-free benefits.


So?

I mentioned this in an earlier post: most countries have some form of public health insurance. This shifts the benefit burden from employers to the government. This reduces the cost of employment and makes businesses more competitive. One of the reasons that the US auto industry has gotten their asses kicked for 40 years is that their overseas competitors aren't having to foot the bill for an extra $15-25K per employee for healthcare costs.

If the US wants to "Make America Great Again", to increase employment and rebuild it's manufacturing sector, they're going to have to look at both the cost of healthcare and the burden of employer-based insurances. Until they do, there's little hope that any large manufacturing base will return to the US.

I was responding to thewiz's argument that ACA is not socialism.
Notice that I said that it "initiates" near total regulation. A classic foot in the door or slippery slope, if you prefer. If we want to be great again socialism is not the way to go. Any saving to large employers will soon be claimed by the labor bosses, while the companies pay higher taxes to provide free health care to half the country--about the half that recieve some form of welfare.

 

[KaraBulut]

I was responding to thewiz's argument that ACA is not socialism.

From dictionary.com:

socialism [soh-shuh-liz-uh m] - a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole.

Since the hospitals, healthcare providers and insurance companies remain non-governmental institutions, it doesn't meet the definition of socialism, nor is it socialized medicine.

What is being proposed is similar to the system in countries like the Netherlands and Germany where there is a combination of public and private insurance. The "public option" would be an additional payer for some insurance policies where the government collects insurance premiums and pays insurance claims (much like they currently do for Medicare). Socialized insurance isn't the kind of "socialism" that tends to be used as a pejorative "scare" word.

 

[ballcaphair]

One way or another patients were covered, including Medicaid. Now we are told without government control millions will die in the streets or some such thing.

Those with preexisting conditions will end up in ER. That is the most expensive place to receive primary care. "One way or another" is NOT cost effective. It is heartbreaking to receive clients who could not afford preemptive care. Two weeks ago we prepped a kid for leg amputation because he had undiagnosed diabetes. They need not "die in the streets" for the whole thing to be expensive, awful and cruel.

 

[thewiz]

One way or another patients were covered, including Medicaid. Now we are told without government control millions will die in the streets or some such thing.

Perhaps you should step away from the White House and Republican Party talking points; I'd suggest volunteering your knowledge and services to a hospital. As a former hospital board and system president, you confuse "control" with "treatment."

The federal government did not take "control" under the ACA. What the federal government did do was eliminate the millions in junk policies that were regularly being issued across this country -- ones that precluded treatment for cancer because the patient didn't have cancer when they applied. Problem is that cancer usually develops and is found without warning. Of course those with the insurance policies then vented on the hospitals and doctors because we had to tell them treatment would be out of their pockets. Or, like my sister who had two prior heart attacks; I looked at her policy issued by a large insurance company that exempted pre-existing conditions. So much for the three hundred she paid each month. She bitched to me that ACA "increased" her cost by $120 per month until I showed her the language and explained it to her; suddenly she was pissed at the insurance company.

Our small, rural hospital had to build a $3.7 million wing for the emergency room but the real reason was to treat all of the people without insurance that entered our facility. Who do you think paid for that $3.7 million along with the need to staff with additional doctors, nurses, specialists, etc? If someone has no insurance and is barely scraping by on their two jobs -- do you think they are paying? No, we increased our prices to insurers -- Blue Cross, Blue Shield, Medicaid, Medicare, etc. And do you think those insurance companies just happily ate up that added cost? Nope....they passed it along to their clients who often are industries, businesses, individuals, and other groups.

Before ACA we were all paying in some manner; ACA holds out hope that we will move people from seeking treatment in emergency rooms where care is more expensive and where outcomes are usually less positive because disease and underlying conditions have degraded the patient. It is THE MOST EXPENSIVE place to deliver care; it is usually one of the least effective. So your "dying in the streets" is pretty accurate. I guess you and Sister Sarah along with the Republican Party do want death panels. They just aren't delivered through the ACA.

 

[rareboy]

Those with preexisting conditions will end up in ER. That is the most expensive place to receive primary care. "One way or another" is NOT cost effective. It is heartbreaking to receive clients who could not afford preemptive care. Two weeks ago we prepped a kid for leg amputation because he had undiagnosed diabetes. They need not "die in the streets" for the whole thing to be expensive, awful and cruel.

This is one of the reasons why health outcomes in the US are so poor when balanced against the case costs, compared to the rest of the world.