Who'd a thunk it? Obamacare not repealed

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 Obamacare not repealed

Post by OTCW » Sat Apr 15, 2017 9:07 am

In my state, there are more opioid prescriptions than there are people. Need to fix that kind of thing, plus obesity, sedentary lifestyle, type 2 diabetes, junk fueled diets, smoking, etc in order to fix healthcare IMO. What the national debate is centered on now is who pays for our health insurance.

I don't think we aren't discussing anything that will lead to an improvement in actual health, but politicians can easily see what side of the line they want to be on by gaging reaction to who they suggest pays for what.

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 Obamacare not repealed

Post by BRUTE » Sat Apr 15, 2017 11:52 am

opioid prescriptions are not the problem - resulting crime and overdoses are. that's easy to fix by legalizing opioids. it'll be super cheap, almost no humans will die because it'll be pure because it'll be cheap, almost no crime resulting because it'll be cheap and won't empower the local criminals who're currently dealing it.

smoking and metabolic syndrome are much harder to fix, because they're cultural problems with lots of momentum.

brute agrees that "who pays for it" does almost nothing to improve the situation.

it's a side effect of a 4 year election cycle. it does not pay off for politicians to fix anything in the long run, all they can benefit from must happen within 4 years. changing a culture of nutrition took several generations of heavy lobbying and law making and propaganda. it's not going to reverse over night - or within 4 years.

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 Obamacare not repealed

Post by Laura Ingalls » Sat Apr 15, 2017 3:21 pm

BRUTE wrote:
Sat Apr 15, 2017 11:52 am
opioid prescriptions are not the problem - resulting crime and overdoses are. that's easy to fix by legalizing opioids. it'll be super cheap, almost no humans will die because it'll be pure because it'll be cheap, almost no crime resulting because it'll be cheap and won't empower the local criminals who're currently dealing it.

smoking and metabolic syndrome are much harder to fix, because they're cultural problems with lots of momentum.

brute agrees that "who pays for it" does almost nothing to improve the situation.

it's a side effect of a 4 year election cycle. it does not pay off for politicians to fix anything in the long run, all they can benefit from must happen within 4 years. changing a culture of nutrition took several generations of heavy lobbying and law making and propaganda. it's not going to reverse over night - or within 4 years.
Alcoholics and Opiod abusers both cost the culture plenty. Drunks can be constantly loaded on $15 of cheap vodka a day. Legalize heroin and making it cheap won't make the addicted functional and it doesn't seem to have social users

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

Post by OTCW » Sat Apr 15, 2017 3:55 pm

For the record, I was talking about legal (prescription) opioids. And there is a legitimate place for them, but abuse leads to addiction. Pill mills are a big part of the problem. Not trying to start an debate over opioid use, but when prescriptions for it are that out of control, there is a definite cost factor that shouldn't exist that affects the price of overall healthcare. Only point I was making. The other societal costs are probably for another debate.

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

Post by BRUTE » Sat Apr 15, 2017 4:21 pm

legal opioids are extremely expensive - because they're so restricted. users end up falling back on the illegal ones for cost reasons, which is where it becomes dangerous, because they're cut and are easy to overdose on.

most opioid users are completely functional, just as most alcoholics are. and heroin would be at $15/lbs if it were legal - it's a plant that can be industrially grown on fields. almost zero cost to society absent prohibition, certainly less than smoking or alcohol, which are way more unhealthy even in pure forms.

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

Post by OTCW » Sat Apr 15, 2017 4:31 pm

They aren't too expensive if your insurance covers them. Just makes insurance more expensive for everybody so that addicted folks can get a buzz and can go to insurance covered rehab. Just pointing out part of the reason for costs going up/health going down.

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

Post by BRUTE » Sat Apr 15, 2017 5:03 pm

sure, but the easiest solution is to lift prohibition and make the addiction affordable.

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

Post by classical_Liberal » Sat Apr 15, 2017 11:53 pm

Legalization and the subsequent price drop of opioids would also eliminate the very real, very large cost of ER's flooded with addicts attempting to get a fix from the medical stuff. Not to mention reduction in the medical costs for treatment centers, most of whom serve a populace who does not want to quit the addition, rather are forced into the medical system unwillingly.

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

Post by IlliniDave » Sun Apr 16, 2017 6:01 am

Many of them are also forced into the prison system. My family has had to deal with opium-derived addiction and it's consequences. On the surface addiction is not what I'd call a good thing, but our culture makes it a lot worse through our stubborn attempts to make it go away. I have to suspect that legislating mandatory healthy diet/lifestyle in an attempt to "fix" healthcare costs would largely result in the same: ultimately a far higher cost, both in dollars and otherwise.

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

Post by Stahlmann » Sun Apr 16, 2017 6:04 am

BRUTE wrote:
Sat Apr 15, 2017 4:21 pm
legal opioids are extremely expensive - because they're so restricted. users end up falling back on the illegal ones for cost reasons, which is where it becomes dangerous, because they're cut and are easy to overdose on.

most opioid users are completely functional, just as most alcoholics are. and heroin would be at $15/lbs if it were legal - it's a plant that can be industrially grown on fields. almost zero cost to society absent prohibition, certainly less than smoking or alcohol, which are way more unhealthy even in pure forms.
Are you sure about possible negative effects of opoids?
I think they are no 1 in every research in terms of personal/social harm.

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

Post by BRUTE » Sun Apr 16, 2017 10:05 am

Stahlmann wrote:
Sun Apr 16, 2017 6:04 am
Are you sure about possible negative effects of opoids?
I think they are no 1 in every research in terms of personal/social harm.
brute used to quote the wiki article on heroin side effects, because it just used to say "constipation". now it's been updated to this:
Wikipedia wrote:Common side effects include respiratory depression (decreased breathing) and about a quarter of those who use heroin become physically dependent. Other side effects can include abscesses, infected heart valves, blood borne infections, constipation, and pneumonia.
respiratory depression is dangerous if combined with alcohol, which is why opioids should never be combined with it or other drugs. education is key here to prevent accidental overdose.

the abscesses and infections are simply a side effect of unclean needle use. needles are cheap, and some cities even have free needle exchange programs that would easily prevent this.

constipation, on the other hand, still has to be dealt with.

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

Post by classical_Liberal » Sun Apr 16, 2017 12:13 pm

BRUTE wrote:
Sun Apr 16, 2017 10:05 am
constipation, on the other hand, still has to be dealt with.
How many carbs in prunes?

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

Post by BRUTE » Sun Apr 16, 2017 1:09 pm

all of it is carbs. and they're not really good for digestion. like most fiber, they mostly push out shit by adding more shit to the whole pipeline - creating new constipation. classical_Liberal would be well advised not to fall into the "more shit is better" trap, it's untrue. more shit is just more shit. uneducated humans confuse constipation with not shitting a lot. the goal isn't to shit a lot. the goal is to shit well.

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

Post by scriptbunny » Wed Apr 26, 2017 9:01 pm

GOP is pushing a new amendment to AHCA without community rating and essential health benefits. Is this something conservative voters actually want or is the Freedom Caucus just way off base here?

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

Post by George the original one » Wed Apr 26, 2017 10:55 pm

Saw the headline, haven't read the details. And I'm not a conservative voter, so bound to dislike it ;-)

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

Post by IlliniDave » Thu Apr 27, 2017 8:28 am

I can't speak for conservative voters (though I'm much closer to conservative than I am to "progressive").

My very superficial understanding is that the amendment will leave it up to the states to determine what coverage requirements an insurer must adhere to in the policies they offer, rather than it being dictated from the federal government as in ACA. So it sounds like we'd be going back to an ad hoc patchwork.

I don't think even ACA has "strict" community rating. I also don't know that it's purely "conservative" thing, but healthy people don't want to pay higher premiums than they feel their personal risk warrants (to subsidize the less healthy). Unfortunately, the only way to reduce premiums from an insurance perspective is to leave at least some portion of the population (perhaps all) more on their own for healthcare costs. In other words, this might lower premiums for some and will necessarily raise them for others. And the lower premiums might come with less coverage (you get what you pay for).

It's maybe unfortunate that the problem tends to get looked at from a year-over-year perspective rather than from a lifelong perspective. From the longer perspective it makes more sense that the young/healthy will chip in significantly to pay the bills of the old/sick as long as it comes with the promise that down the road the flow of money will reverse when eventually the young/healthy become the old/sick.

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

Post by scriptbunny » Thu Apr 27, 2017 4:08 pm

@IlliniDave I ask about conservatives since I feel like progressives are more comfortable with or actively like the redistributionist nature of EHBs/community rating.

Do you like this amendment to AHCA? Have you seen any reaction from self-identifying conservative friends or family members, either positive or negative?

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

Post by IlliniDave » Thu Apr 27, 2017 6:25 pm

scriptbunny wrote:
Thu Apr 27, 2017 4:08 pm
@IlliniDave I ask about conservatives since I feel like progressives are more comfortable with or actively like the redistributionist nature of EHBs/community rating.

Do you like this amendment to AHCA? Have you seen any reaction from self-identifying conservative friends or family members, either positive or negative?
Me personally: I have not seen enough of it (plus I think it's still sort of being haggled over) to have an opinion. I'm okay with state definition of essential services. I don't much like what I've heard about the changes to community rating. If you take it to the extreme, since everyone is a unique risk, everybody is in a pool of one and there is effectively no such thing as insurance any more. I don't mind something simple-minded like charging older people more than younger people (ACA did that) but if you start doing it based on current health we wind up back with the chronically ill not being able to buy insurance (not meaningful insurance anyway). And somehow they think they'll make a system work where people can opt out, but insurers can't refuse people.

I haven't spoken about it to anyone I know who self-identifies as a conservative that does not have a job which allows them to buy group insurance through their employer. So they really don't have a horse in the race. In general they like getting rid of the individual mandate and more state versus federal control (I don't know why because we live in a state run by bigger morons than the ones in Washington). I guess they see it as, "Yeah, they're morons all right, but at least they're our morons."

As an aside, ironically, ACA caused all of our employer sponsored insurance to be sharply reduced in quality because no company wants to pay the "Cadillac tax". I never understood the rationale for punishing an employer for offering generous healthcare benefits.

The math is undeniable. If you're not going to reform the healthcare service industry, the only way to make premiums go down is to make the insured (in the aggregate) pay more out of pocket. You can do that by shortening the list of "essential services", raising deductibles, or by quarantining people with chronic health problems and telling them, "Sorry, pal, you're on your own."

I think the latter is where we're headed, more-or-less for the same reason people don't keep an emergency fund, save adequately for their kids college, or for their own retirement. Our culture is financially short-sighted.

Sorry, that was wordy, you were probably looking for yes/no answers, haha.

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

Post by Riggerjack » Wed May 03, 2017 11:26 am

Free medical is worth every penny. Talk to a soldier about the outstanding value received with free medical. (Where is that sarcasm button when I NEED it?)

First, insurance is THE MOST EXPENSIVE way to pay for anything. That's just common sense. Nothing gets cheaper by adding a 3rd party to the transaction. Insurance and government can shift costs, with a premium added, but they have no mechanism for lowering costs. Forget any arguments about power of negotiation, or economies of scale. We aren't manufacturing pins, here.

The reason we even talk about this is because costs have skyrocketed. This is to be expected, as we have removed all forms of price reduction. The same game is played in college tuition. When you remove price incentive, there is no downward pressure on costs anymore.

You can spot this pattern simply. If profit margin and costs are used to justify prices, the pricing system is broken, every time.

We broke the pricing system in medical care by removing prices from the decision tree. Ask your doctor how much a treatment costs, odds are she doesn't know. And the price changes depending on who you are, whether you are insured, the business type treating you, and their primary customer base.

Who pays for insurance has nothing to do with that. Nothing in a single payer system will address that. There is no aspect of healthy living that will fix that.

Our system is currently aligned to maximize profits, and socialize costs. Just the opposite of a free market.

Besides the astoundingly bad service that accompanies single payer systems, they side track criticism into false economies like weight and smokers. Yeah, costs are high, but we can simple mindedly blame smokers, fat people, lawyers, or whatever other unpopular subgroup you like. I haven't heard about how racists raise healthcare costs yet, but give it time....

So, the way I see it, there is a 4 part, simple solution, that will never be implemented by a political class interested in division more than solutions.

Part 1, bring back Cadillac plans for employees. Yes, insurance will get more expensive, and these people will continue to provide upward pressure on prices. But these are the people with the least time, and the most productivity. Cut them some slack.

Part 2, replace payroll taxes with a carbon tax on fossil fuels, at the source. Then expand Medicaid to cover everyone who wants it, but don't increase the budget. This removes a tax on labor, fulfilling both the goal of making labor cheaper, so more jobs, and putting the social cost of healthcare on fossil fuels. Giving incentive to cut fossil fuel use, with minimal market distortion. The fossil fuel tax will automatically increase as use goes down, driving further fuel efficiency. People with free Medicaid will just end up competing with each other in how much time they are willing to dedicate to getting service. Fine, just so I don't have to wait behind them, they can queue as long as they like.

Part 3 is high deductible health insurance, healthcare savings accounts, and universal pricing. A cat scan costs X dollars, at clinic Y, no matter who you are, or what plan you have. Decide for yourself whether you want it. All billing goes to the patient, and it is up to the patient to get insurance to reimburse. Leave it up to the patient to choose where to be serviced. This will put the downward pressure on prices, as clinics are forced to compete on price and service.

Part 4, RFID tags with extreme care directives and legal relief of doctors and clinics for not countering those orders. We need better end of life medical decision making. Our current default of all measures, regardless of costs or benefits evolved out of a system where end of life treatment was a cot, and a bottle of snake oil. We can now keep gomers alive and miserable for years after they want it all to end. This is where the money goes. Fat people, smokers, etc just get here sooner. A decrease in spending of 50% in the last 6 months of life will decrease costs of the whole system by 25%. There is lots of low hanging fruit here.

There. All fixed. Nobody dying for lack of insurance, better services and better prices, with more jobs, and reduced carbon footprint as bonuses.

However, there is no room allowed in this plan for congressmen to blackmail anyone, and no ongoing political division, so don't expect anything like this solution to come from our "leaders". There's just no incentive for them to fix this.

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

Post by Riggerjack » Wed May 03, 2017 12:11 pm

Oh, and if you really want to fix healthcare costs, make all meds over the counter, and legalize all recreational drugs.

Make FDA approval a product certification, like a UL rating in electronics. Suddenly those $1billion approvals won't be part of the cost of providing services.

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

Post by bryan » Wed May 03, 2017 12:37 pm

according to Consumer Reports, bankruptcies going down year over year, can be attributed to ACA: http://www.consumerreports.org/personal ... ankruptcy/

of course hard to pick out any specific causations here.. e.g. maybe it is enough to just outlaw lifetime limits or pre-existing condition clauses.

I would hope the decrease in medical bankruptcies means falling healthcare costs across the board.. since instead of the healthcare providers sending debts to collections, they can be distributed amongst the tax-payers, insurance-holders.

@Riggerjack, you lament on price discovery being perverted, but then advocate for "universal pricing..no matter who you are, or what plan you have."? Just making sure :P

I figured ACA is the worst possible realistic permutation of the machine's state. Can only get better from here, right? I hope so.. If there is a way to screw it up, they'll find a way.

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

Post by IlliniDave » Wed May 03, 2017 12:53 pm

bryan wrote:
Wed May 03, 2017 12:37 pm
I would hope the decrease in medical bankruptcies means falling healthcare costs across the board.. since instead of the healthcare providers sending debts to collections, they can be distributed amongst the tax-payers, insurance-holders.
I do not believe that is the case. My guess is expanded medicare.

bryan wrote:
Wed May 03, 2017 12:37 pm
I figured ACA is the worst possible realistic permutation of the machine's state. Can only get better from here, right? I hope so.. If there is a way to screw it up, they'll find a way.
Oh, just wait until yet another set of legislators have a go at it. :) You'd be hard pressed to find a more inept group anywhere in this country.

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

Post by enigmaT120 » Wed May 03, 2017 1:40 pm

IllinoisDave wrote: "If you take it to the extreme, since everyone is a unique risk, everybody is in a pool of one and there is effectively no such thing as insurance any more."

That's something I don't see pointed out very often when I hear people complain about other people (in my case, it's the families with 10 kids if those still exist) driving up my insurance costs. If you account for everybody's pluses and minuses health wise in life, the premiums would just equal the prices of the services you use. A guy on work was ragging on bicyclists riding sans helmets, and said if they get a head injury it shouldn't be covered by insurance. I had to point out that he rides a motorcycle, which no matter how you dress is way more dangerous per mile than riding a bicycle with or without a helmet. "Oh yeah." It's always other people's lifestyle choices we want to blame, not our own.

Disclaimer: I ride many more miles on both motorcycles and bicycles than he does but only wear a bicycle helmet to ride in the dark so that I can use my Blackburn Flea headlight.

On another note, I like Riggerjack's suggestions and would probably vote for him.

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

Post by Riggerjack » Wed May 03, 2017 1:55 pm

@Riggerjack, you lament on price discovery being perverted, but then advocate for "universal pricing..no matter who you are, or what plan you have."? Just making sure :P
Perhaps I was unclear. The price you pay at clinic X for service Y, should match the price I pay at clinic X for service Y. None of the prices at clinic A should need to match the prices at clinic X. Clinic A should be COMPETING with clinic X, using price, service, and expertise to compete for business.

Currently, none of this is in any way true.

My neighbor works in billing in the local hospital. Where, as near as I can tell from stories she tells, the bill is entirely dependent on how she feels about you. She has so many programs, and funds at her disposal, so much discretion to write off bills, that the best form of insurance seems to be to engage her sympathy.

Needless to say, she blames lawyers for healthcare costs...

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

Post by Riggerjack » Wed May 03, 2017 2:13 pm

On another note, I like Riggerjack's suggestions and would probably vote for him.
Having the solution is entirely different from being able to implement such a solution. And life is too short to waste on public office.
Oh, just wait until yet another set of legislators have a go at it. :) You'd be hard pressed to find a more inept group anywhere in this country.
I honestly don't think they are inept. I think their incentives are aligned to encourage divisiveness, and short term, band aid solutions. It takes a move from the executive branch, using the bully pulpit, and all their political capital on "signature legislation", to get a solution thru Congress. Obama could have done that, early in his term. Instead, he let Pelosi sit in a backroom with special interests, and make the ACA monstrosity, then force it through, unread. Slapping his name on it, in the end. I don't know if this was because he had little interest in a solution, or if he simply wanted to use the political capital elsewhere. In any case, it's clear the current guy isn't going to put together a comprehensive solution.

As near as I can tell, when the red team got all three houses, the only thing they could agree on was that ISPs should be able to sell our privacy.

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