Who'd a thunk it? Obamacare not repealed

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George the original one
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Who'd a thunk it? Obamacare not repealed

Post by George the original one » Fri Mar 24, 2017 10:03 pm

Apparently Republicans can't get their act together well enough to repeal Obamacare. Sometime last year, I mused that they'd squabble on the replacement, but considered the repeal to be a done deal. That gives them another year to figure out how to do it, but some incumbents will probably be concentrating on being re-elected.

ThisDinosaur
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Re: Who'd a thunk it? Obamacare not repealed

Post by ThisDinosaur » Fri Mar 24, 2017 10:16 pm

None of them want to be held responsible for taking away people's health insurance. The repubs backed themselves into a corner by trash talking the ACA all these years and never preparing a competing plan they could agree on.The more time passes, the more people will remember Barack and his healthcare plan with rose colored glasses. Noone will remember the rapidly rising premiums, and gradual loss of options on the exchanges. If repeal is accomplished in the next two years, i predict the backlash will give democrats the political clout to get a single payer or public option passed next time they have the ball.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Sat Mar 25, 2017 7:30 am

Meh, it took 8 mos from the time the ACA was rolled out until it hit the president's desk while a single party controlled both houses and the White House. It's not a simple thing to accomplish (repeal would be simple, it's replacing it that's tricky). The country needs to put politics aside and collectively put our heads together to come up with a structure that will maximize healthcare for everyone within the limits of available resources. Ironically, Trump seems to be the only person in Washington that sees that, or at least the only one I've heard calling for it. Everyone else has their little battle lines drawn and are willing to drive the car over a cliff rather than consider any sort of collaboration or compromise.

There are good things about ACA but it sounds like it will implode in the next few years. As someone who expects to lose the option to buy health insurance through my employer right around that time, this is a big deal to me.
Last edited by IlliniDave on Sat Mar 25, 2017 8:18 am, edited 1 time in total.

OTCW
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Re: Who'd a thunk it? Obamacare not repealed

Post by OTCW » Sat Mar 25, 2017 7:54 am

As of now, the only carrier offering a plan on the exchange in my area has announced that they won't do so next year. Not sure what I will do.

scriptbunny
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Re: Who'd a thunk it? Obamacare not repealed

Post by scriptbunny » Sat Mar 25, 2017 9:28 am

I never thought they'd succeed on repeal. It's a big social program and a lot of right-leaning constituents in Republican districts would lose out. Never a good look to take away people's health insurance for either party.

Personally, I expect the exchanges to get gradually worse over the next few years -- unsuccessful markets with one provider will drop to none, age rating will increase, essential health benefits will be gradually eroded by HHS. Not a "collapse" but a consistent decline hitting the pre-Medicare elderly and rural populations hardest. Republicans will say it's all the Democrats' fault while simultaneously not having any real suggestions as to how to fix. And then whenever Dems get control back, they'll make revisions which will hopefully include a Medicare buy-in for 55+ and public option to stabilize the market.

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Re: Who'd a thunk it? Obamacare not repealed

Post by Tyler9000 » Sat Mar 25, 2017 9:46 am

OTCW wrote:As of now, the only carrier offering a plan on the exchange in my area has announced that they won't do so next year. Not sure what I will do.
Be sure to look at the insurance providers off the exchange to see what they offer. You won't get subsidies, but you'll likely get a lot more options.

Personally, I think both parties are waiting for this to happen and insurers to abandon the exchange so that they can blame the other side and finally say what they really want. Good ol' politics. In the meantime, do the best you can with whatever options you have. For all the noise, nothing has changed.

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BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE » Sat Mar 25, 2017 10:21 am

OTCW wrote:As of now, the only carrier offering a plan on the exchange in my area has announced that they won't do so next year. Not sure what I will do.
it is interesting though that the ACA seems to be actually failing catastrophically, despite what Liberals keep yelling. is this a case of reality meets ideology?

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Re: Who'd a thunk it? Obamacare not repealed

Post by ether » Sat Mar 25, 2017 10:48 am

"The AHCA would reduce the deficit relative to current law by $337 billion over a decade. Approximately $1.2 trillion less would be spent over that time, while $900 billion less in tax revenue would be collected"

Image

The new law is essentially Obamacare without the tax increases and MASSIVE cuts to insurance subsidies for the poor, aka kicking the poor off insurance! And you can simultaneously piss off the most active age group, seniors, by effectively doubling their premiums by lifting the cap on how you can charge the old.

I mean really?! Tax cuts for the highest income earners by taking away healthcare from millions of working class americans and increasing the cost for the elderly, come on!! Not the best first move for a new government, save that for the end of your term! :twisted:

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Sat Mar 25, 2017 11:29 am

ether wrote: The new law is essentially Obamacare without the tax increases and MASSIVE cuts to insurance subsidies for the poor, aka kicking the poor off insurance! And you can simultaneously piss off the most active age group, seniors, by effectively doubling their premiums by lifting the cap on how you can charge the old.

I mean really?! Tax cuts for the highest income earners by taking away healthcare from millions of working class americans and increasing the cost for the elderly, come on!! Not the best first move for a new government, save that for the end of your term! :twisted:
Well, there is no new law. There was a draft bill that never even made it to the floor for a vote. Pouring more money into a broken system, even if it's someone else's money (i.e., the "wealthy"), isn't going to fix anything.

I still like the idea I've been mentioning periodically for the last year: taxpayer-funded universal catastrophic coverage then let the insurance industry offer products for people who prefer pre-paid health expense plans instead of just insurance.

One of the big problems they have to get around is that the entire system is set up for state-regulated insurance companies who effectively (along with the states explicitly) regulate providers. It will take some sort of new paradigm to emerge (like the few healthcare coops out there) which will require a lot of players relinquish their control to allow providers and patients to develop a "free market solution". But getting 50 different states and thousands of counties to behave in their residents' best interest may be asking too much.

I never thought this way before, but I might have to start thinking in terms of the medical care and medical insurance landscape and pick a new place to retire. We're on the path to wild inconsistencies location-by-location.

ThisDinosaur
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Re: Who'd a thunk it? Obamacare not repealed

Post by ThisDinosaur » Sat Mar 25, 2017 2:24 pm

+1 to iDave's Universal Catastrophic coverage. That idea spreads the real risk maximally, and still leaves room for choice among providers and private insurance for non bankruptcy level health issues. Has any politician specifically endorsed this idea? Last time you mentioned it, someone posted a link to Paul Ryan's A Better Way plan. But i didnt see anything like that in there. And its certainly not in AHCA.

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Re: Who'd a thunk it? Obamacare not repealed

Post by scriptbunny » Sat Mar 25, 2017 3:26 pm

The Cassidy-Collins plan would do something similar. It lets states choose whether they want to dole money either according to the ACA or universal catastrophic coverage. Though we'd have to wait to see a CBO score to see cost, efficacy, coverage, insurance quality, etc. If the GOP leadership actually tried to get support around that bill, I bet more than a few Democrats would join in (and they'd be dumb not to). But in order to fund universal catastrophic coverage it would cost as much as or even more than ACA. So at the end of the day since it wouldn't repeal ACA taxes it would be non-starter within the GOP.

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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Sat Mar 25, 2017 5:10 pm

scriptbunny wrote:The Cassidy-Collins plan would do something similar. It lets states choose whether they want to dole money either according to the ACA or universal catastrophic coverage. Though we'd have to wait to see a CBO score to see cost, efficacy, coverage, insurance quality, etc. If the GOP leadership actually tried to get support around that bill, I bet more than a few Democrats would join in (and they'd be dumb not to). But in order to fund universal catastrophic coverage it would cost as much as or even more than ACA. So at the end of the day since it wouldn't repeal ACA taxes it would be non-starter within the GOP.
I don't think your last sentence is quite true. The GOP obliviously does not operate in lock-step the way some other parties do, else they would have rammed the recent ill-fated bill down our throat. We've seen what that gets us. The surtax aspect of it would be objectionable to some republicans though, no doubt.

I think the flaw in plan you mention is that once again it leaves the door open for disparate implementations as a function of the state (ACA is already that way by itself, and that plan adds even more variability). ACA really isn't working well anywhere that I know of, just that in some places it's blowing up a little more slowly than others. Encouraging people to cling to that model is probably a bad idea.

If the federal taxpayers' money is going into it, I think there should be uniformity in implementation. As a worklife-long taxpayer of federal taxes I should be able to go to any state and find a consistent medical care landscape insofar as it's covered by pooled money taken from people nationwide. That's not a huge burden. Medicare already operates that way. This would also direct the federal taxpayer's money to where it's most critically needed (people/families with severe medical crises)

I don't know that universal catastrophic-style coverage would be all that expensive relatively speaking. Most people incur the huge majority of their medical expenses in old age, and that's covered by Medicare. To pool the younger healthier population for a lesser level of insurance should be doable, although it would probably require an additional payroll tax (i.e., everyone's got ongoing skin in the game). Certainly premiums for prepaid healthcare policies would be cheaper than what people are used to paying now because the maximum liability of the insurance provider is capped.

Unless we completely change the paradigm, we all have to expect to pay more for medical care. It will be a major budget item for everyone going forward. There's just no way around that in the bloated system we have now.

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Ego
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Re: Who'd a thunk it? Obamacare not repealed

Post by Ego » Sat Mar 25, 2017 5:51 pm

IlliniDave wrote: It will be a major budget item for everyone going forward. There's just no way around that in the bloated system we have now.
Ahem. I refrained from doing my taxes until this was resolved so that I would know the MAGI number I would have to limbo under. As it stands I am able to get under the limit without using a SEP-IRA. That may change in the future.

Four years ago I posted this video and book viewtopic.php?t=3256 (scroll down to the last post) where David Goldhill proposes government-funded catastrophic care for all. With four years of wisdom under my belt I wonder if....

1) The ACA/AHCA fiasco isn't all a big charade to deliver us to catastrophic-care-for-all.
2) And catastrophic-care-for-all isn't just one step toward full government funding of all medical care.

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Re: Who'd a thunk it? Obamacare not repealed

Post by scriptbunny » Sat Mar 25, 2017 6:24 pm

Ego wrote:And catastrophic-care-for-all isn't just one step toward full government funding of all medical care.
100% this.

@IlliniDave: Of course I don't think the GOP works in perfect lock step. Cassidy and Collins are both Republican senators putting forward a good faith effort at creating a bipartisan-appealing bill. However, the leadership (read: McConnell and Ryan) gets to dictate the schedule and keeping ACA tax cuts is largely a non-starter to them. It would rile up the Freedom Caucus, is contrary to their own personal beliefs, and be more like single-payer than ACA is. So while I personally think Cassidy-Collins is an interesting prospect, I also think it's dead in the water.

I agree that were the CC bill taken up, there are problems that need be ironed out in it, including state-by-state variability. Though while I am no big fan of the exchanges, I would disagree that ACA isn't working anywhere. I live in Massachusetts where we had Romneycare and our exchanges are doing well. My understanding is that exchanges tend to fare better in places where there's a healthier risk pool (more young people) and more concentrated medical resources, i.e. urban areas. (see:map) I do agree there is a steady decline in insurers in a lot of areas though (again, in more elder-concentrated and rural regions). One could come up with a way to fix that, a way that Dems have been yammering about for eight years: a public option. But, again, I doubt we'll see that with this Congress.

All that said, I personally wouldn't mind scrapping the exchanges entirely for a universal catastrophic care system, but that's because I have a very difficult time imagining one that would be cost effective (both for patients and for the govt) without being full-on universal healthcare and all the tax increases that would entail. Unless you have a system which covers necessary prescriptions, preventative care, and recuperative therapies, or at least makes those things financially accessible, I expect higher occurrence of expensive hospitalization and medical emergencies. And I may be misinterpreting what you're saying by "maximum liability of the insurance provider is capped" but I don't think insurance sans no lifetime limits is effective catastrophic care.

CS
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Re: Who'd a thunk it? Obamacare not repealed

Post by CS » Sat Mar 25, 2017 6:34 pm

Oh boy, this place.

1. The ACA is not blowing up/failing. Right from the CBO to your ears.
http://www.politico.com/story/2017/03/o ... red-236016
Repealing it, would, however blow up the deficit.
https://www.forbes.com/sites/stancollen ... af5e46c34c

2. Premium increases are actually much less than the five years prior to it's implementation.
http://www.factcheck.org/2015/02/slower ... der-obama/

3. The radical rise in costs in the last year was thanks to Rubio (R) and company. They passed a bill pulling money from the Insurance pool, timed to happen just before the elections (yes, you are paying through the nose so more Republicans can get elected. How do you like them now?)
https://www.nytimes.com/2015/12/10/us/p ... .html?_r=0

Yes, the failing number of companies on the exchanges is a problem. It can be fixed with cooperation. When the Dems were working on ACA eight years ago, they were talking to the Repubs. A lot. Pelosi is a beast when it comes to getting legislation through. Ryan, by contrast, is pure rube.

Yesterday was a good day.

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Re: Who'd a thunk it? Obamacare not repealed

Post by scriptbunny » Sat Mar 25, 2017 6:49 pm

CS wrote:The ACA is not blowing up/failing. Right from the CBO to your ears... Yes, the failing number of companies on the exchanges is a problem. It can be fixed with cooperation.
We've seen the CBO fail to include GOP intransigence in their calculations before...

CS
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Re: Who'd a thunk it? Obamacare not repealed

Post by CS » Sat Mar 25, 2017 6:52 pm

Also, even more impressive, the lower premium rate rise is for a product that is heads and tails above the pre Obamacare era products.
ACA requires:
- No exclusions for pre-existing conditions
- No lifetime limits
- Children on parents plan until age 26 when living at home
- A whole slew of required preventative care that was not necessarily part of any plan before.

This new product is a much better deal for the money paid.

CS
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Re: Who'd a thunk it? Obamacare not repealed

Post by CS » Sat Mar 25, 2017 6:53 pm

scriptbunny wrote: We've seen the CBO fail to include GOP intransigence in their calculations before...
:lol:

Well, no one can predict the future. That is why we need to pay attention and do some holding of accountabilities when stunts are pulled.

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Re: Who'd a thunk it? Obamacare not repealed

Post by OTCW » Sat Mar 25, 2017 9:48 pm

CS wrote:
2. Premium increases are actually much less than the five years prior to it's implementation.
http://www.factcheck.org/2015/02/slower ... der-obama/
That article is over 2 years old. My premium for a bronze plan was $150 a month then. Now it is $350 a month.

Next year there aren't any exchange plans being offered in my area. I live in a medium to large city with lots of young people.

The ACA is dying and needs fixing. That mess the Republicans developed wasn't going to fix anything and it rightfully died. There is so much political theater going on on both sides over healthcare that I doubt it ever gets fixed.

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Re: Who'd a thunk it? Obamacare not repealed

Post by Dragline » Sat Mar 25, 2017 11:00 pm

Well, the die was cast when the GOP leaders proposed what was essentially Obama-care light. If your problem with Obamacare is government involvement with healthcare, then the whole thing made no sense from the beginning. This is what the Freedom Caucus ran on and got elected on, and so it was not surprising they opposed this.

As Good Captain Kirk reminded Bad Spock in "Mirror Mirror" -- "Conquest is easy. Control is not." This is the lesson neither the US has learned internationally, nor the current ruling party domestically.

Unless an actual different and better plan is proposed, Obama has won, pending full Medicaid expansion by states. Once Medicaid expansion covers everyone, you'll have de facto Single Payer outside of employer-sponsored plans. Most Republicans officials outside of the Freedom Caucus do not actually oppose this when their jobs are on the line. Which they are.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Sun Mar 26, 2017 7:43 am

Ego wrote:
Ahem. I refrained from doing my taxes until this was resolved so that I would know the MAGI number I would have to limbo under. As it stands I am able to get under the limit without using a SEP-IRA. That may change in the future.

Four years ago I posted this video and book viewtopic.php?t=3256 (scroll down to the last post) where David Goldhill proposes government-funded catastrophic care for all. With four years of wisdom under my belt I wonder if....

1) The ACA/AHCA fiasco isn't all a big charade to deliver us to catastrophic-care-for-all.
2) And catastrophic-care-for-all isn't just one step toward full government funding of all medical care.
Paragraph 1: Not sure what you're getting at. For both 2015 and 2016 I've looked at my future situation (on the exchange for the county where I expect my official retirement residence to be) and yeah, I'd qualify for subsidies, and could have an essentially "free" Bronze plan but it would leave me liable for a large annual deductible. If I recall correctly one that was on the order of 40% of my gross "income". Of course that expense may or may not be realized in a given year.

Paragraph 2: I wasn't here four years ago, I don't think. Never claimed it was my idea, just the one I'd heard somewhere (possibly here) that really sounded like a step towards a solution. Congrats to you for being ahead of me.

Paragraph 3: 1) is likely, I think. 2) probably is as well, although nothing is government-funded, it would be taxpayer-funded. Although the fraction of my dna that runs libertarian would squeal, I'm not totally against a single-payer system.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Sun Mar 26, 2017 8:45 am

scriptbunny wrote:
@IlliniDave:
... And I may be misinterpreting what you're saying by "maximum liability of the insurance provider is capped" but I don't think insurance sans no lifetime limits is effective catastrophic care.
I do think you misunderstand. Just for the sake of argument let's say that we have a taxpayer-funded universal system that covers everything above $10,000 in medical costs annually. Then lets say iDave learns he has liver disease and it's only treatable via transplant. From the experience of a friend of mine, I'll estimate that the cost for that procedure and the recovery as nearly $1M, so lets call it $1M even. The universal catastrophic would cover $990,000 and I'd be liable for $10,000. But if I'd bought some sort of supplemental policy at the start of the year, let's say one that covers everything after a $3000 annual deductible, my insurance company would have to pay something between $7,000 and $10,000 rather than something between $997,000 and $1,000,000 as they would under the present system. That would mean the premiums for me and everyone else in my risk pool would be much lower. There wouldn't be an explicit lifetime maximum for a private insurer, though implicitly it could not exceed $10,000 times a person's remaining longevity (depending on how much insurance the person bought). The key is that it's limited for any given year.

Something like 90% of the total healthcare costs are incurred by something like 10% of the population, meaning there is a small minority of people who are running up huge bills (those numbers might be a tad exaggerated, but that doesn't invalidate the point). The most efficient approach to handle those cases is through the largest risk pool possible--everyone--with everyone contributing. The most inefficient way to do it is to break up all the risk pools by county then again by provider.

In addition, this would similarly relieve medicaid of much of it's current liability and it's possible that the present funding levels could cover an even larger swath of the low-income population because it would never have to pay more than $10,000 for a given person in a given year, and should average less per person.

Of course, we'd all see an increase in our federal taxes to pay for it. I'd be a proponent of a payroll tax like medicare that everyone pays. I dislike surtaxes targeting higher income earners (for the record, I do not get hit with those surtaxes myself), but I wouldn't slit my wrists over it as compromise that keeps the new payroll tax lower. That's arguably a little self serving because I'm about to deliberately lower my income to sub-median, so it seems sorta unfair that I'd get the advantage of the new system without a lifetime of paying into it at my peak income, but the same happened with the first enrollees for medicare and SS, and we survived it.

Of course we could sit around and identify special cases where people with extraordinary circumstances might have medical costs that hit hard under any given system. And the numbers I threw out might not be the most precise. I'm practical by nature, and wouldn't want good to be derailed by squabbles over perfect. Implement the good then once in place work to perfect it. The saddest thing of all is that the topic is cloaked in politics, which more than anything else I know of impedes people from coming together and solving problems in the current climate.
Last edited by IlliniDave on Sun Mar 26, 2017 10:46 am, edited 1 time in total.

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Ego
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Re: Who'd a thunk it? Obamacare not repealed

Post by Ego » Sun Mar 26, 2017 9:26 am

IlliniDave wrote: Although the fraction of my dna that runs libertarian would squeal, I'm not totally against a single-payer system.
I was exhausted when I wrote that. My post didn't say what I intended. Sorry about that.

I don't care who got there first. I thought it was interesting that the ACA was essentially a Romney idea that was implemented nation-wide by Obama. Goldhill is a dyed in the wool liberal who proposed the catastrophic care idea (His book is titled Catastrophic Care) which was promptly picked up by the libertarian Cato Institute and may be implemented by Agent Orange.

As we've seen with Medicare, once the system is in place, all it takes is periodic expansions to create taxpayer funded healthcare for all. Once funded they become the third-rail.

A Russian mole implementing socialist policies in America with the help of American libertarians. :D

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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE » Sun Mar 26, 2017 10:42 am

brute likes the idea of catastrophic coverage, be it federally funded or not. but, true catastrophic coverage would likely be very cheap. and also wouldn't solve the entire problem.

roughly, brute would divide medical issues in this country into 3 categories:

1)day to day stuff that always occurs - vaccinations, checkups, MRIs, could be paid out of pocket reasonably. here, medical care is no better than a credit card installment plan.

2)existing or anticipated very high cost conditions - diabetes, heart disease (in many cases), stroke (in many cases), potentially Alzheimers and others. these are extremely costly, but can in many cases be seen approaching 1-2 decades in advance, and fully prevented from advancing with appropriate care. once severe enough, there is no way around them any more. they're catastrophic in the cost sense, but not in the sense that they're very unlikely to happen. pre-existing conditions that are catastrophically expensive go here.

3)very rare, high cost conditions that bankrupt most individuals, but are low-risk enough for the risk to be pooled - car accidents, strokes and heart disease in non-metabolic-syndrome humans, probably MS..

a low-cost catastrophic coverage would prevent #3. this is the advantage most western (and many other) countries have in their single-payer systems. it is actually extremely cheap to cover extremely rare, catastrophic-cost incidents. this would lower the risk of medical bankruptcy by picking the short straw at some point in life.

#1 is unnecessary expect for the extreme poor - Medicaid solves it, or at least attempts to. subsidizing the extreme poor to get health checkups and vaccinations works well as long as their % is small enough.

it would also help if medications and procedures were cheaper - in the US, many things cost several times what they cost in other western countries. brute is convinced that a freer market with fewer litigation nonsense and lobbying would help reduce costs here.

unfortunately, the elephant in the room is #2, and there is no way out of highly likely, catastrophic cost conditions. insurance doesn't work if the risk is higher. if it's also preventable or treatable on the individual level, this becomes a subsidy by the healthy to the sick, not because of bad luck, but because of bad behavior/treatment in the past. the risk can't be spread around because it's too high. instead of 1 human paying $100,000 with a 100% chance, it's now 2 humans paying $50,000 with a 100% chance.

it could make sense to sub-divide #2 further into existing conditions that were bad luck, vs. existing conditions that are definitely the individual humans' fault. smoking and lung cancer, for example, brute doesn't care to subsidize. same goes for type 2 diabetes and other metabolic syndrome diseases. he's more sympathetic to humans suffering from MS. tumors are weird - science just doesn't know enough to even categorize them well.

just as a reminder, leading causes of death in the US by rate:
1)cardiovascular disease
2)tumors
3)respiratory disease (probably closest to "natural death", mainly appears at 60+ years)
4)diabetes
5)influenza/pneumonia (also pretty much an old human thing, 60+)
6)alzheimers
7)motor vehicle accidents
8)kidney failure (more likely in the old)
9)infections (more likely in the old)
10)firearms

of these, 2-4 are petty much death by old age. 2 are non-medical - accidents and firearm deaths.

the remaining, heart disease, (some) tumors, diabetes, alzheimers, are neither low-risk in a population with chronic metabolic syndrome, nor are they cheap.

subsidizing a large part of the population for catastrophic costs is unsustainable no matter who pays the bill. the risk can't be spread around. the cost can't be lowered a lot.

no "health care act" of any sort will be able to fix this. it'll take this generation of humans to die off, and another to grow up without metabolic syndrome. but looking at the tea leaves of statistics, it seems that the rate of metabolic syndrome is increasing, not decreasing.

the house is on fire, and no insurance policy can put the fire out.

edit:

some countries deal with this much better. in Singapore, the government takes out ads on taxis and subway stations, fat shaming their population into working out and restricting caloric intake. brute wouldn't necessarily agree with the methods recommended, but the Singaporean government seems very aware of the cause of their cost-increase in health care, whereas the US or other western countries just try blaming it on the other party ("sick humans are moochers", "single payer would save everything, only evil capitalists stand in the way!").

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Re: Who'd a thunk it? Obamacare not repealed

Post by OTCW » Sun Mar 26, 2017 11:40 am

Brute makes a lot of good points.

A way to go after #2 may be to phase in/out optional insurance for lifestyle diseases.

You want to take care of yourself and have a slim chance of these diseases developing, you don't opt to purchase this supplemental insurance.

You want to eat like a 12 year old in a candy store, sit in the couch all day, smoke, drink, do drugs? That's fine because there is insurance available for you that covers a lot of the consequenses of behaving that way. It's subsidized now, but each year the subsidy goes down, so unless you can afford it, you'd be wise to make some changes in the next 10 to 15 years.

Most of the people that can't adapt by then will be dead of their ailments by then (as they would under any healthcare system), but the next generations would have plenty of incentive (staying alive and being financially solvent) to not go down the path of that lifestyle.

I also like Brute'approach to #1 - pay as you go with subsidies for the poor for day to day care.

#3 everyone gets/universal coverage.

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